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RRC150018-00 ELKHART GENERAL HOSPITAL (Active)
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Main Details
Name
ELKHART GENERAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC150018-00
Medicare Provider Number
150018
Additional Details
Current Program Status
Active
Registration Date
7/14/2021
Participating Start Date
10/1/2021
Participating Approval Date
7/30/2021
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Beacon Health System, Inc.
JEFFREY P. COSTELLO, CFO
(574) 647-3549
Primary Contact
Beacon Health System-Elkhart General Hospital
Holly Kaczmarek, Director of Pharmacy
(574) 523-3447
Addresses
Street Address
600 EAST BLVD
ELKHART, IN 46514
Billing Address
Beacon Health System, Inc
615 N Michigan St
South Bend, IN 46601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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