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ASCENSION RX 1001
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
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Allen Parod, President
(317) 338-7094
Contract Pharmacy Representative
Ascension Rx
Angela Pascuzzi, Pharmacist In Charge
(833) 633-7279
Signed By Date
7/15/2021
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