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FRANCISCAN ALLIANCE, INC.
DSH150109 FRANCISCAN HEALTH LAFAYETTE
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH LAFAYETTE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150109
Entity Address
1701 SOUTH CREASY LANE
LAFAYETTE, IN 47905
Medicare Provider Number
150109
Participating Start Date
4/26/2021
Last Recertification Date
8/21/2024
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
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jason Geddes, Regional CFO
(765) 502-4599
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
10/15/2024
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