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CORAM HEALTHCARE CORPORATION OF INDIANA
DSH150007 COMMUNITY HOWARD REGIONAL HEALTH
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Covered Entity Details
Entity Name
COMMUNITY HOWARD REGIONAL HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150007
Entity Address
3500 SOUTH LAFOUNTAIN
KOKOMO, IN 46902
Medicare Provider Number
150007
Participating Start Date
1/1/2016
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF INDIANA
Pharmacy Address
DBA CORAM CVS/SPECIALTY INFUSION SERVICE
1290 ARROWHEAD COURT
SUITE A
CROWN POINT, IN 46307
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
1/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Joseph Hooper, President & CEO
(765) 776-8580
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
10/15/2018
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