Contract Pharmacy Details

COMMUNITY HOSPITAL OF NOBLE
CAH151323-00 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.

Covered Entity Details

Entity Name

COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH151323-00

Entity Address

207 NORTH TOWNLINE ROAD
LAGRANGE, IN 46761

Medicare Provider Number

151323

Participating Start Date

4/1/2011

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

COMMUNITY HOSPITAL OF NOBLE

Pharmacy Address

401 N SAWYER RD
KENDALLVILLE, IN 46755-2568

Pharmacy Comments

Contract Details

Approval Date

10/24/2012

Contract Begin Date

10/24/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Browning, COO
(260) 373-8407

Contract Pharmacy Representative

Dave Hunter, COO
(260) 347-8491

Signed By Date

9/3/2012

340B Drug Pricing Program Database