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DSH150012 ST. JOSEPHS REG MED CENTER S. BEND (Active)
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Main Details
Name
ST. JOSEPHS REG MED CENTER S. BEND
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150012
Medicare Provider Number
150012
Additional Details
Current Program Status
Active
Registration Date
10/25/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/27/2023
Last Recertification Date
9/8/2024
Contacts
Authorizing Official
Loyola Medicine
Melissa M. Lukasick, CFO Illinois Region
(708) 216-5723
Primary Contact
Loyola Medicine
Zohra Saleem, Regional 340B Manager
(708) 216-3875
Addresses
Street Address
5215 HOLY CROSS PARKWAY
MISHAWAKA, IN 46545
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating Start Date 1/1/2019, Termination Date 1/1/2020, Reinstatement 1/1/2024
10/26/2023
Participating from effective date (4/1/2017) until terminated effective date (1/1/2018), reinstatement effective date (01/01/2019)
10/16/2018
April 2025
April 2025
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