Contract Pharmacy Details

WELLSPRING PHARMACY - NORTH
DSH150074 Community Health Network, Inc.

Covered Entity Details

Entity Name

Community Health Network, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH150074

Entity Address

1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219

Medicare Provider Number

150074

Participating Start Date

4/1/2008

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

WELLSPRING PHARMACY - NORTH

Pharmacy Address

7120 CLEARVISTA DRIVE
SUITE 1900
INDIANAPOLIS, IN 46256

Pharmacy Comments

12/20/10 UPDATED PHARMACY NAME AND ADDR (WASVISIONARY ENTERPRISES, INC. DBA WELLSPRING PHARMACIES - EAST, NORTH, AND SOUTH, 7330 SHADELAND STATION, SUITE 200);

Contract Details

Approval Date

11/17/2010

Contract Begin Date

11/17/2010

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/28/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

11/9/2010

340B Drug Pricing Program Database