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ST. VINCENT HOSPITAL AND HEALTH CARE CEN
DSH150084 ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
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Covered Entity Details
Entity Name
ST. VINCENT HOSPITAL AND HEALTH CARE CENTER D/B/A Ascension St. Vincent Indianapolis
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150084
Entity Address
2001 WEST 86TH STREET
INDIANAPOLIS, IN 46260
Medicare Provider Number
150084
Participating Start Date
9/3/2008
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ST. VINCENT HOSPITAL AND HEALTH CARE CEN
Pharmacy Address
D/B/A ASCENSION RX 1503
2001 W 86TH ST
INDIANAPOLIS, IN 46260
Pharmacy Comments
Contract Details
Approval Date
10/8/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Aaron Joel Feldman, CEO
(317) 338-2455
Contract Pharmacy Representative
Wendy LeMasters, Director of Ambulatory Pharmacy Services
(317) 338-2097
Signed By Date
10/8/2016
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