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FRANCISCAN ALLIANCE INC
DSH150109 FRANCISCAN HEALTH LAFAYETTE
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH LAFAYETTE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150109
Entity Address
1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905
Medicare Provider Number
150109
Participating Start Date
4/26/2021
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN ALLIANCE INC
Pharmacy Address
DBA FRANCISCAN OUTPATIENT PHARMACY - LAF
1701 S CREASY LN
ROOM 1K71
LAFAYETTE, IN 47905
Pharmacy Comments
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2024
Ownership change
Contacts
Covered Entity Signing Official
Jason Geddes, Regional CFO
(765) 502-4599
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
4/7/2021
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