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COMMUNITY SURGERY CENTER
FQHCLA391 219 HEALTH NETWORK INC
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Covered Entity Details
Entity Name
219 HEALTH NETWORK INC
Subdivision Name
219 Health Network
Type
Health Center Program Look-Alike
340B ID
FQHCLA391
Entity Address
100 W. Chicago Ave. STE F
East Chicago, IN 46312
Grant Number
LALCS32751
Participating Start Date
10/1/2019
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COMMUNITY SURGERY CENTER
Pharmacy Address
801 MACARTHUR BLVD STE 102
MUNSTER, IN 46321-2916
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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