340B Drug Pricing Program Database
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DSH150021CJ Parkview Hospital (Terminated)
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Main Details
Name
Parkview Hospital
Subdivision Name
PRMC PHI HEART FAILURE CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH150021CJ
Medicare Provider Number
150021
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/5/2019
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
1/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Parkview Health
Jeanne Wickens, CFO
(260) 373-8407
Primary Contact
Parkview Health
Stephanie Dickmeyer, 340B Program Supervisor
(260) 266-4408
Addresses
Street Address
11108 PARKVIEW CIRCLE DR
FORT WAYNE, IN 46845
Billing Address
PARKVIEW MEMORIAL HOSPITAL, INC
2200 Randallia Drive
FORT WAYNE, IN 46805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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