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ACCREDO HEALTH GROUP, INC.
DSH150169 COMMUNITY HOSPITAL OF INDIANA INC.
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL OF INDIANA INC.
Subdivision Name
Community Hospital North
Type
Disproportionate Share Hospital
340B ID
DSH150169
Entity Address
7150 CLEARVISTA DRIVE
INDIANAPOLIS, IN 46256
Medicare Provider Number
150169
Participating Start Date
4/1/2016
Last Recertification Date
8/12/2024
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
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathleen R. Krusie, SVP President North Region
(317) 621-6095
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/15/2018
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