Covered Entity Details

DSH150002AP THE METHODIST HOSPITALS (Active) - information as of 4/28/2025 12:40:46 AM

Main Details

Name

THE METHODIST HOSPITALS

Subdivision Name

SL ACUTE HEMODIALYSIS - HEMODIALYSIS

Type

Disproportionate Share Hospital

Rural

340B ID

DSH150002AP

Medicare Provider Number

150002

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/15/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/25/2024

Last Recertification Date

Contacts

Authorizing Official

Methodist Hospitals
Matthew Shawn Doyle, President & CEO
(219) 886-4608

Primary Contact

Methodist Hospital
Laura Majoch, Controller
(219) 886-5390

Addresses

Street Address

8701 BROADWAY
MERRILLVILLE, IN 46410

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IN	100268630B,100268630A,300076369,300023258	1467504555,1245940386,1932672888
IL	350868133002,35086813303	1467504555,1245940386

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH150002AA	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Recovery Room	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AB	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Operating Room	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AC	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Gamma Knife Radiology Therpeutic	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AD	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Electrophysiology	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AE	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / CT Scan	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AF	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Cardiac Diagnostics	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AG	Child	DSH	THE METHODIST HOSPITALS	ONCOLOGY INFUSION CENTER - Oncology Infusion center	200 E 89TH AVE	MERRILLVILLE	IN	Active
DSH150002AH	Child	DSH	THE METHODIST HOSPITALS	SL - Infusion Center - SL - Infusion Center	8701 Broadway	Merrillville	IN	Active
DSH150002AJ	Child	DSH	THE METHODIST HOSPITALS	Methodist Clinic - Endocrinology - SL	200 E. 89th Avenue	Merrillville	IN	Active
DSH150002AK	Child	DSH	THE METHODIST HOSPITALS	SL - SurgCtr-GI Lab - SL - SurgCtr-GI Lab	101 E. 87th Ave	Merrillville	IN	Active
DSH150002AL	Child	DSH	THE METHODIST HOSPITALS	Methodist Hospitals - Post Acute Care - Home Health	303 E. 89th Ave	Merrillville	IN	Active
DSH150002AM	Child	DSH	THE METHODIST HOSPITALS	SL LABOR & DELIVERY - LABOR & DELIVERY	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AN	Child	DSH	THE METHODIST HOSPITALS	SL RADIOLOGY DIAGNOSTICS / IR - INTERVENTIONAL RADIOLOGY	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AP	Child	DSH	THE METHODIST HOSPITALS	SL ACUTE HEMODIALYSIS - HEMODIALYSIS	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002AQ	Child	DSH	THE METHODIST HOSPITALS	CARDIAC REHAB - CARDIAC REHAB - CAREFIRST BUILDING	753 EAST 81ST AVENUE	MERRILLVILLE	IN	Active
DSH150002C	Child	DSH	THE METHODIST HOSPITALS	Southlake Emergency Department	8701 Broadway	Merrillville	IN	Active
DSH150002D	Child	DSH	THE METHODIST HOSPITALS	Southlake Neuroscience	200 E. 89th Ave.	Merrillville	IN	Active
DSH150002E	Child	DSH	THE METHODIST HOSPITALS	Southlake Wound Clinic	8701 Broadway	Merrillville	IN	Active
DSH150002F	Child	DSH	THE METHODIST HOSPITALS	Southlake Merrillville Ambulatory Surgery Center (MASC)	101 E. 87th Ave.	Merrillville	IN	Active
DSH150002G	Child	DSH	THE METHODIST HOSPITALS	Southlake Specialty Health	8701 Broadway	Merrillville	IN	Active
DSH150002K	Child	DSH	THE METHODIST HOSPITALS	Radiology Diagnostic	8701 Broadway	Merrillville	IN	Active
DSH150002L	Child	DSH	THE METHODIST HOSPITALS	Cardiac Catherization	8701 Broadway	Merrillville	IN	Active
DSH150002M	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS ENDOSCOPY CENTE	8895 BROADWAY	MERRILLVILLE	IN	Active
DSH150002N	Child	DSH	THE METHODIST HOSPITALS	METHODIST SURGICAL SERVICES / Radiology Diagnostic	101 EAST 87TH AVE	MERRILLVILLE	IN	Active
DSH150002P	Child	DSH	THE METHODIST HOSPITALS	METHODIST SURGICAL SERVICES / CT Scan	101 EAST 87TH AVE	MERRILLVILLE	IN	Active
DSH150002Q	Child	DSH	THE METHODIST HOSPITALS	METHODIST SURGICAL SERVICES / Radiology Ultrasound	101 EAST 87TH AVE	MERRILLVILLE	IN	Active
DSH150002R	Child	DSH	THE METHODIST HOSPITALS	METHODIST SURGICAL SERVICES / Magnetic Resonance Imaging	101 EAST 87TH AVE	MERRILLVILLE	IN	Active
DSH150002S	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Radiology Ultrasound	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002T	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Respiratory Therapy	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002U	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Radiation Oncology Radiology Therpeutic	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002V	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Radioisotope Nuclear Medicine	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002W	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Electroencephalography Neuro EDX	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002X	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Magnetic Resonance Imaging	8701 BROADWAY	MERRILLVILLE	IN	Active
DSH150002Y	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Mammography Radiology Diagnostic	101 EAST 87TH AVE	MERRILLVILLE	IN	Active
DSH150002Z	Child	DSH	THE METHODIST HOSPITALS	METHODIST HOSPITALS INC / Hyperbarics Clinic	303 EAST 89TH AVENUE	MERRILLVILLE	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100268630A	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300076369	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300023258	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		35086813303	4/8/2025 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	4/8/2025 10:57 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1245940386	4/8/2025 10:57 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	4/8/2025 10:57 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1932672888	4/8/2025 10:57 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	4/8/2025 10:57 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1467504555	4/8/2025 10:57 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	4/8/2025 10:57 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1245940386	4/8/2025 10:57 AM
Medicaid Billing	NPI: State	Insert	Change Request		IL	4/8/2025 10:57 AM
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Doyle, Matthew Shawn President & CEO Methodist Hospitals 2198864608	10/25/2024 6:15 AM
Details	340B ID	Update	New Registration		DSH150002AP	10/25/2024 6:15 AM
Details	Entity Name	Update	New Registration	METHODIST HOSPITALS INC	THE METHODIST HOSPITALS	10/25/2024 6:15 AM
Details	Entity Subname	Update	New Registration	SL ACUTE HEMODIALYSIS	SL ACUTE HEMODIALYSIS - HEMODIALYSIS	10/25/2024 6:15 AM
Dates	Participating Approval Date	Update	New Registration		10/25/2024 6:15:11 AM	10/25/2024 6:15 AM
Details	State	Update	New Registration	Pending	Approved	10/25/2024 6:15 AM
Dates	Signed By Date	Update	New Registration		10/15/2024 2:32:07 PM	10/25/2024 6:15 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/25/2024 6:15 AM
Addresses	Main Address	Insert	New Registration		8701 BROADWAY MERRILLVILLE, IN 46410	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100268630B	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		350868133002	10/15/2024 2:32 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	10/15/2024 2:32 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467504555	10/15/2024 2:32 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	10/15/2024 2:32 PM
Contacts	Authorizing Official	Insert	New Registration		Doyle, Matthew Shawn President & CEO Methodist Hospitals 2198864608	10/15/2024 2:32 PM
Contacts	Primary Contact	Insert	New Registration		Majoch, Laura Controller Methodist Hospital 2198865390	10/15/2024 2:32 PM
Details	Assistance Received From Date	Insert	New Registration			10/15/2024 2:32 PM
Details	Assistance Received To Date	Insert	New Registration			10/15/2024 2:32 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2024 2:32 PM
Details	Grant Number	Insert	New Registration			10/15/2024 2:32 PM
Details	340B ID	Insert	New Registration			10/15/2024 2:32 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2024 2:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2024 2:32 PM
Details	Medicare Provider Number	Insert	New Registration		150002	10/15/2024 2:32 PM
Details	Entity Name	Insert	New Registration		METHODIST HOSPITALS INC	10/15/2024 2:32 PM
Details	NOFO Number	Insert	New Registration			10/15/2024 2:32 PM
Details	Program Code	Insert	New Registration		DSH	10/15/2024 2:32 PM
Details	Entity Subname	Insert	New Registration		SL ACUTE HEMODIALYSIS	10/15/2024 2:32 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2024 2:32 PM
Details	State	Insert	New Registration		Pending	10/15/2024 2:32 PM
Dates	Registration Date	Insert	New Registration		10/15/2024 2:32:02 PM	10/15/2024 2:32 PM
Dates	Signed By Date	Insert	New Registration			10/15/2024 2:32 PM
Dates	Start Date	Insert	New Registration			10/15/2024 2:32 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2024 2:32 PM
Terminations	Termination Date	Insert	New Registration			10/15/2024 2:32 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2024 2:32 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2024 2:32 PM