340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PARKVIEW RANDALLIA OUTPATIENT PHARMACY
CAH151323-00 COMMUNITY HOSPITAL OF LAGRANGE COUNTY, INC.
Print
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
PARKVIEW RANDALLIA OUTPATIENT PHARMACY
Pharmacy Address
2200 RANDALLIA DR
FORT WAYNE, IN 46805
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/7/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael P. Browning, Senior Vice President and Chief Financial Officer
(260) 373-8407
Contract Pharmacy Representative
Anthony Scott, Director
(260) 373-3464
Signed By Date
4/14/2014
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session