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FRANCISCAN ALLIANCE INC
DSH150015 FRANCISCAN HEALTH MICHIGAN CITY
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH MICHIGAN CITY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150015
Entity Address
3500 FRANCISCAN WAY
MICHIGAN CITY, IN 46360
Medicare Provider Number
150015
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
FRANCISCAN ALLIANCE INC
Pharmacy Address
DBA FRANCISCAN OUTPATIENT PHARMACY - MIC
3500 FRANCISCAN WAY FL 1
MICHIGAN CITY, IN 46360
Pharmacy Comments
Contract Details
Approval Date
7/22/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2024
Ownership change
Contacts
Covered Entity Signing Official
Justin Kats, Division CFO - Crown Point & Michigan City
(219) 757-6403
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
7/11/2024
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