Contract Pharmacy Details

FRANCISCAN ALLIANCE, INC.
DSH150004 FRANCISCAN HEALTH HAMMOND

Covered Entity Details

Entity Name

FRANCISCAN HEALTH HAMMOND

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150004

Entity Address

5454 HOHMAN AVE
HAMMOND, IN 46320

Medicare Provider Number

150004

Participating Start Date

4/1/2013

Last Recertification Date

8/31/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

FRANCISCAN ALLIANCE, INC.

Pharmacy Address

DBA FRANCISCAN HOME INFUSION PHARMACY MU
757 45TH AVE
SUITE 102
MUNSTER, IN 46321

Pharmacy Comments

Contract Details

Approval Date

4/11/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

TOM GRYZBEK, PRESIDENT
(219) 933-2074

Contract Pharmacy Representative

Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900

Signed By Date

4/11/2014

340B Drug Pricing Program Database