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RRC150015-06 FRANCISCAN HEALTH MICHIGAN CITY (Terminated)
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Main Details
Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
FRANCISCAN HEALTH MICHIGAN CITY INF - Infusion Center at Crown Point, Ground Floor
Type
Rural Referral Center
Rural
Yes
340B ID
RRC150015-06
Medicare Provider Number
150015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/3/2023
Participating Start Date
7/1/2023
Participating Approval Date
6/7/2023
Last Recertification Date
8/26/2023
Termination Date
Termination Reason
10/1/2024
Change of covered entity type
Contacts
Authorizing Official
Franciscan Alliance
Justin Kats, Division CFO - Crown Point & Michigan City
(219) 757-6403
Primary Contact
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Addresses
Street Address
1201 S. MAIN STREET
CROWN POINT, IN 46307-8481
Billing Address
Franciscan Health Michigan City
3500 Franciscan Way
Michigan City, IN 46360
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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