340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FAGEN PHARMACY #28
DSH150002 THE METHODIST HOSPITALS
Print
Covered Entity Details
Entity Name
THE METHODIST HOSPITALS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150002
Entity Address
600 GRANT ST
GARY, IN 46402
Medicare Provider Number
150002
Participating Start Date
4/1/2003
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
FAGEN PHARMACY #28
Pharmacy Address
DEMOTTE DRUGS INC.
571 W. 14TH STREET
CHICAGO HEIGHTS, IL 60411
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/2/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Matthew Shawn Doyle, President & CEO
(219) 886-4608
Contract Pharmacy Representative
Gerald A. Fagen, President
(219) 987-6468
Signed By Date
4/13/2015
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