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FRANCISCAN ALLIANCE INC
DSH150015 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150015
Entity Address
3500 FRANCISCAN WAY
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
FRANCISCAN ALLIANCE INC
Pharmacy Address
DBA FRANCISCAN OUTPATIENT PHARMACY - MIC
3500 FRANCISCAN WAY FL 1
MICHIGAN CITY, IN 46360
Pharmacy Comments
Contract Details
Approval Date
10/25/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Trish L. Weber, VP Operations/CNO
(219) 877-1766
Contract Pharmacy Representative
Franciscan Alliance
Eugene Harber, Corporate Pharmacy Manager, 340b Operations
(219) 932-2300 Ext: 35561
Signed By Date
10/12/2018
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