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CAREMARK KANSAS SPECIALTY PHARMACY
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
CAREMARK KANSAS SPECIALTY PHARMACY
Pharmacy Address
CVS/SPECIALTY OR CARELONRX SPECIALTY PHA
11162 RENNER BLVD
LENEXA, KS 66219
Pharmacy Comments
Contract Details
Approval Date
7/22/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin Kats, Division CFO - Crown Point & Michigan City
(219) 757-6403
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/11/2024
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