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FRANCISCAN ALLIANCE INC
RRC150015-00 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Rural Referral Center
340B ID
RRC150015-00
Entity Address
3500 Franciscan Way
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2019
Last Recertification Date
8/22/2023
Entity Termination Date
10/1/2024
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
9/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Trish L. Weber, VP Operations/CNO
(219) 877-1766
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
7/12/2019
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