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ASCENSION RX 1001
DSH150084 ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
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Covered Entity Details
Entity Name
ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150084
Entity Address
2001 WEST 86TH STREET
INDIANAPOLIS, IN 46260
Medicare Provider Number
150084
Participating Start Date
9/3/2008
Last Recertification Date
9/3/2024
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
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Erica Lynn Wehrmeister, Regional President
(317) 338-7094
Contract Pharmacy Representative
Ascension Rx
Angela Pascuzzi, Pharmacist In Charge
(833) 633-7279
Signed By Date
7/19/2021
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