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ASCENSION RX 1001
DSH150088D 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
ORTHOPEDIC SURGERY CENTER
Type
Disproportionate Share Hospital
340B ID
DSH150088D
Entity Address
2610 ENTERPRISE DR.
ANDERSON, IN 46013
Medicare Provider Number
150088
Outpatient Facility Provider Number
Participating Start Date
1/1/2017
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
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 Pharmacy Services, LLC
Lynn Eschenbacher, Chief Pharmacy Officer
(314) 884-0593
Signed By Date
10/15/2021
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