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ACCREDO HEALTH GROUP, INC.
DSH150100 ST. MARYS MEDICAL CENTER D/B/A ASCENSION ST VINCENT EVANSVILLE
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER D/B/A ASCENSION ST VINCENT EVANSVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150100
Entity Address
3700 WASHINGTON AVE
EVANSVILLE, IN 47750
Medicare Provider Number
150100
Participating Start Date
7/1/2018
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Daniel Allen Parod, President
(317) 338-7094
Contract Pharmacy Representative
Accredo Health Group
Kristina Robinson, Contract Analyst
(407) 854-6555
Signed By Date
7/17/2018
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