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FRANCISCAN ALLIANCE, INC.
DSH150090 FRANCISCAN HEALTH- DYER
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH- DYER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150090
Entity Address
24 JOLIET STREET
DYER, IN 46311-1799
Medicare Provider Number
150090
Participating Start Date
1/1/2024
Last Recertification Date
8/23/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
FRANCISCAN ALLIANCE, INC.
Pharmacy Address
DBA FRANCISCAN HOME INFUSION PHARMACY LA
1501 HARTFORD ST RM G540
LAFAYETTE, IN 47904
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pamela Jo Ott, Chief Financial Officer
(219) 228-1015
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
7/8/2024
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