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ASCENSION RX 1001
DSH150088 ST. VINCENT ANDERSON REGIONAL HOSPITAL D/B/A ASCENSION ST. VINCENT ANDERSON
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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
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Margaret M Johnson, President
(765) 456-5301
Contract Pharmacy Representative
Ascension Rx
Angela Pascuzzi, Pharmacist In Charge
(833) 633-7279
Signed By Date
10/15/2021
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