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HUNTINGTON MEMORIAL HOSP
CAH151323-00 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
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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
HUNTINGTON MEMORIAL HOSP
Pharmacy Address
2001 STULTS RD
HUNTINGTON, IN 46750
Pharmacy Comments
Contract Details
Approval Date
11/16/2012
Contract Begin Date
11/16/2012
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
Robert Myers, COO
(260) 463-9373
Contract Pharmacy Representative
Darlene Garrett, COO
(260) 355-3681
Signed By Date
9/7/2012
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