340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ELKHART GENERAL HOSPITAL
DSH150058 MEMORIAL HOSPITAL OF SOUTH BEND, INC
Print
Covered Entity Details
Entity Name
MEMORIAL HOSPITAL OF SOUTH BEND, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150058
Entity Address
615 N MICHIGAN STREET
SOUTH BEND, IN 46601
Medicare Provider Number
150058
Participating Start Date
1/1/2007
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
ELKHART GENERAL HOSPITAL
Pharmacy Address
OUTPATIENT PHARMACY
600 EAST BLVD
ELKHART, IN 46514
Pharmacy Comments
Contract Details
Approval Date
10/12/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/20/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JEFFREY P. COSTELLO, CFO
(574) 647-3549
Contract Pharmacy Representative
Susan Hawes, Pharmacy Director
(574) 523-3447
Signed By Date
10/12/2013
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session