340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MEDICAL PARK 11 PHARMACY
DSH150021 Parkview Hospital
Print
Covered Entity Details
Entity Name
Parkview Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150021
Entity Address
11109 PARKVIEW PLAZA DRIVE
FORT WAYNE, IN 46845
Medicare Provider Number
150021
Participating Start Date
10/1/2015
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MEDICAL PARK 11 PHARMACY
Pharmacy Address
11104 PARKVIEW CIRCLE DR
FORT WAYNE, IN 46845-1704
Pharmacy Comments
Contract Details
Approval Date
10/2/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/7/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stanton Risser, Assoc Chief Financial Officer
(260) 266-9313
Contract Pharmacy Representative
Medical Park 11
Shery Grosjean, Pharmacy Manager
(260) 266-4507
Signed By Date
10/2/2015
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