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COMMUNITY HOSPITAL
FQHCLA391D 219 HEALTH NETWORK INC
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Covered Entity Details
Entity Name
219 HEALTH NETWORK INC
Subdivision Name
219 Health Network, Inc.
Type
Health Center Program Look-Alike
340B ID
FQHCLA391D
Entity Address
8141 Kennedy Ave
Highland, IN 46322-1128
Grant Number
LALCS32751
Participating Start Date
4/1/2020
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COMMUNITY HOSPITAL
Pharmacy Address
THE MUNSTER MED RES FOUNDATION
901 MACARTHUR BLVD
MUNSTER, IN 46321
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia A Johnson, CEO
(219) 703-2585
Contract Pharmacy Representative
St Catherine Hospital
Elizabeth Ann Clements, Director of 340B Program
(219) 703-1236
Signed By Date
10/17/2022
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