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ST. MARY'S HEALTH, INC.
DSH150100 ST. MARYS MEDICAL CENTER D/B/A ASCENSION ST VINCENT EVANSVILLE
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER D/B/A ASCENSION ST VINCENT EVANSVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150100
Entity Address
3700 WASHINGTON AVE
EVANSVILLE, IN 47750
Medicare Provider Number
150100
Participating Start Date
7/1/2018
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
ST. MARY'S HEALTH, INC.
Pharmacy Address
D/B/A ASCENSION RX 1501
801 SAINT MARYS DR
ST MARYS MED BLDG
EVANSVILLE, IN 47714
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Allen Parod, President
(317) 338-7094
Contract Pharmacy Representative
St. Vincent Evansville
Joseph E Merkel, Pharmacy Manager
(812) 485-7362
Signed By Date
7/15/2019
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