Contract Pharmacy Details

AFFILIATED HEALTH SERVICES, INC.
DSH150088 ST. VINCENT ANDERSON REGIONAL HOSPITAL D/B/A ASCENSION ST. VINCENT ANDERSON

Covered Entity Details

Entity Name

ST. VINCENT ANDERSON REGIONAL HOSPITAL D/B/A ASCENSION ST. VINCENT ANDERSON

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150088

Entity Address

2015 JACKSON STREET
ANDERSON, IN 46016

Medicare Provider Number

150088

Participating Start Date

1/1/2017

Last Recertification Date

8/27/2024

Pharmacy Details

Pharmacy Name

AFFILIATED HEALTH SERVICES, INC.

Pharmacy Address

DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334

Pharmacy Comments

Contract Details

Approval Date

7/20/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/27/2022
Ownership change

Contacts

Covered Entity Signing Official

Nicholas J Theohares, VP of Operations
(765) 646-8303

Contract Pharmacy Representative

Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770

Signed By Date

7/20/2020

340B Drug Pricing Program Database