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QUIK SCRIPTS OF NORTHWEST INDIANA, LLC
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
QUIK SCRIPTS OF NORTHWEST INDIANA, LLC
Pharmacy Address
715 S DIXIE HWY
SUITE C
BEECHER, IL 60401-3668
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
Matthew Shawn Doyle, President & CEO
(219) 886-4608
Contract Pharmacy Representative
Methodist
Jacquelyn Ivankovic, Associate Director of Pharmacy
(219) 738-5807
Signed By Date
7/15/2021
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