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DAMASIUS INC.
DSH150002 THE METHODIST HOSPITALS
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Covered Entity Details
Entity Name
THE METHODIST HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150002
Entity Address
600 GRANT ST
GARY, IN 46402
Medicare Provider Number
150002
Participating Start Date
4/1/2003
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
DAMASIUS INC.
Pharmacy Address
DBA: VYTO'S PHARMACY 1
6949 KENNEDY AVE STE C
HAMMOND, IN 46323
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/19/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Raymond Grady, Chief Executive Officer
(219) 886-4432
Contract Pharmacy Representative
Methodist
Jacquelyn Ivankovic, Associate Director of Pharmacy
(219) 738-5807
Signed By Date
7/15/2019
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