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COMMUNITY HOSPITAL
FQHCLA391P 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
FQHCLA391P
Entity Address
1400 S Lake Park Ave Ste 407
Hobart, IN 46342-6791
Grant Number
LALCS32751
Participating Start Date
7/1/2022
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
1/6/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia A Johnson, CEO
(219) 703-2585
Contract Pharmacy Representative
219 Health Network Inc.
Patricia A Johnson, CEO
(219) 703-2585
Signed By Date
1/6/2023
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