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RRC150042-00 GOOD SAMARITAN HOSPITAL (Active)
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Main Details
Name
GOOD SAMARITAN HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC150042-00
Medicare Provider Number
150042
Additional Details
Current Program Status
Active
Registration Date
4/13/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/18/2022
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Good Samaritan Hospital
Matthew S Schuckman, CFO
(812) 885-3334
Primary Contact
Good Samaritan Hospital
Mark Shane Wilson, Director of Pharmacy
(812) 885-3864
Addresses
Street Address
520 S. Seventh St.
VINCENNES, IN 47591
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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