Contract Pharmacy Details

WELLSPRING PHARMACY - NOBLESVILLE
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 - NOBLESVILLE

Pharmacy Address

9669 E. 146TH ST. #150
NOBLESVILLE, IN 46060-5005

Pharmacy Comments

Contract Details

Approval Date

12/12/2012

Contract Begin Date

1/1/2013

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

Michael Blanchet, COO
(317) 355-5930

Contract Pharmacy Representative

Kyle B. Fisher, CEO
(317) 621-7342

Signed By Date

10/1/2012

340B Drug Pricing Program Database