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ST. JOSEPH REGIONAL MEDICAL CTR
DSH150012 ST. JOSEPHS REG MED CENTER S. BEND
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Covered Entity Details
Entity Name
ST. JOSEPHS REG MED CENTER S. BEND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150012
Entity Address
5215 HOLY CROSS PARKWAY
MISHAWAKA, IN 46545
Medicare Provider Number
150012
Participating Start Date
1/1/2024
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
ST. JOSEPH REGIONAL MEDICAL CTR
Pharmacy Address
INFUSION PHARMACY
5215 HOLY CROSS PARKWAY
MISHAWAKA, IN 46545
Pharmacy Comments
Contract Details
Approval Date
10/16/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert Sink, Vice President Finance
(574) 335-4654
Contract Pharmacy Representative
Saint Joseph Health System
Jason Jablonski, Admin Director Clinical Services
(574) 335-2525
Signed By Date
10/15/2018
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