Covered Entity Details

DSH150074AJ COMMUNITY HOSPITALS OF INDIANA, INC. (Terminated) - information as of 6/2/2025 8:28:41 AM

Main Details

Name

COMMUNITY HOSPITALS OF INDIANA, INC.

Subdivision Name

Work-Site Care Clinic -N

Type

Disproportionate Share Hospital

Rural

340B ID

DSH150074AJ

Medicare Provider Number

150074

Outpatient Facility Provider Number

150074

Additional Details

Current Program Status

Terminated

Registration Date

7/15/2014

Participating Start Date

10/1/2014

Participating Approval Date

9/8/2014

Last Recertification Date

8/31/2016

Termination Date
Termination Reason

4/1/2017
DSH percentage below statutory minimum

Contacts

Authorizing Official

Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337

Primary Contact

Scott Hufford, Pharmacy Director
(317) 621-5354

Addresses

Street Address

8101 Clearvista Parkway, Suite 110
Indianapolis, IN 46256

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?
No

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
DSH150074A	Child	DSH	Community Health Network, Inc.	Community Cancer Center North	7979 N. Shadeland Ave.	Indianapolis	IN	Active
DSH150074AA	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Physical Therapy and Rehab - Neuro Specialty Prog	8501 E. 56th Street Suite 140	Indianapolis	IN	Terminated
DSH150074AB	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Physical Therapy, Rehab & Imaging Ctr - Speedway	1011 Main Street, Suite 130	Indianapolis	IN	Terminated
DSH150074AC	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Rehab & Sports Medicine - East	10122 E. 10th Street - Suite 225	Indianapolis	IN	Terminated
DSH150074AD	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Sleep Lab	7250 Clearvista Drive Suite 350	Indianapolis	IN	Terminated
DSH150074AE	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Rehab & Sports Medicine Ctr - Shadeland	2040 N. Shadeland Ave - Suite 100	Indianapolis	IN	Terminated
DSH150074AF	Child	DSH	Community Health Network, Inc.	GMHC Behavioral Health Services	3000 S. S.R. 135, Suite 230	Greenwood	IN	Terminated
DSH150074AG	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Work-Site Care Clinic - S	8921 Southpointe Drive Suite B1	Indianapolis	IN	Terminated
DSH150074AH	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Work-Site Care Clinic - E	1500 N. Ritter Avenue Suite 100	Indianapolis	IN	Terminated
DSH150074AJ	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Work-Site Care Clinic -N	8101 Clearvista Parkway, Suite 110	Indianapolis	IN	Terminated
DSH150074AK	Child	DSH	Community Health Network, Inc.	Operating Room-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AL	Child	DSH	Community Health Network, Inc.	Wound Ostomy-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AM	Child	DSH	Community Health Network, Inc.	Post Anesthesia Care-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AN	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Cardiac Testing Nuclear-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074AP	Child	DSH	Community Health Network, Inc.	CT Scan-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AQ	Child	DSH	Community Health Network, Inc.	Cardiac Cath Lab-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AR	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Cardiac EP Lab-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074AS	Child	DSH	Community Health Network, Inc.	Respiratory Therapy-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AT	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Physical Therapy-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074AU	Child	DSH	Community Health Network, Inc.	Heart Station-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AV	Child	DSH	Community Health Network, Inc.	Cardiac Testing-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074AW	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	COMMUNITY HEART AND VASCULAR TESTIN	8075 N SHADELAND AVE	INDIANAPOLIS	IN	Terminated
DSH150074AX	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Cardiac Testing Echo-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074AY	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Endoscopy Center-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074AZ	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Pulmonary Rehab-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Terminated
DSH150074B	Child	DSH	Community Health Network, Inc.	COMMUNITY REGIONAL CANCER CARE CENTER	1400 NORTH RITTER AVENUE	INDIANAPOLIS	IN	Active
DSH150074BA	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	COMMUNITY N SHADELAND AVE	8075 N SHADELAND AVE	INDIANAPOLIS	IN	Terminated
DSH150074BB	Child	DSH	Community Health Network, Inc.	HEALTHY HEART FAILURE CENTER	8075 N SHADELAND AVE	INDIANAPOLIS	IN	Active
DSH150074BC	Child	DSH	Community Health Network, Inc.	Emergency Department-CHVH	8075 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074BD	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Nuclear Medicine - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BE	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	CT Scan - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BF	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	MRI - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BG	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Shelbourne Therapy - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BH	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	EKG - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BJ	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Cardiac Testing - Echo - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BK	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Cardiac Testing - General - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BL	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Oncology - CHWV	3630 Guion Road	Indianapolis	IN	Terminated
DSH150074BM	Child	DSH	COMMUNITY HOSPITAL OF INDIANA INC.	Wound Center - CHWV	3520 Guion Road # 100	Indianapolis	IN	Terminated
DSH150074BN	Child	DSH	Community Health Network, Inc.	Community Cancer Center North / Radiation	7979 N. Shadeland Ave	Indianapolis	IN	Active
DSH150074BP	Child	DSH	Community Health Network, Inc.	MEDICAL AND RADIATION ONCOLOGY / Radiation	1440 E COUNTY LINE RD	INDIANAPOLIS	IN	Active
DSH150074BQ	Child	DSH	Community Health Network, Inc.	BEHAVIORAL HEALTH SERVICES AT SOUTH - Psychiatric/Psychological Services	1030 E COUNTY LINE RD	INDIANAPOLIS	IN	Active
DSH150074BR	Child	DSH	Community Health Network, Inc.	COMMUNITY CANCER CENTER NORTH - Oncology-Cancer Care Center	7979 N SHADELAND AVE	INDIANAPOLIS	IN	Active
DSH150074BS	Child	DSH	Community Health Network, Inc.	ADULT BEHAVIORAL HEALTH SERVICES - Warren Township Alcohol and Drug Services	2040 N SHADELAND AVENUE	INDIANAPOLIS	IN	Active
DSH150074BT	Child	DSH	Community Health Network, Inc.	COMMUNITY INFUSION CENTER-SPEEDWAY - Infusion Center Speedway	1011 MAIN ST	SPEEDWAY	IN	Terminated
DSH150074BU	Child	DSH	Community Health Network, Inc.	COMMUNITY INFUSION ANDERSON - Infusion Center Anderson	3125 S SCATTERFIELD RD	ANDERSON	IN	Active
DSH150074BV	Child	DSH	Community Health Network, Inc.	COMMUNITY CANCER CENTER NORTH - CRCC PET/CT North	7979 N SHADELAND AVE	INDIANAPOLIS	IN	Active
DSH150074BW	Child	DSH	Community Health Network, Inc.	MEDICAL AND RADIATION ONCOLOGY - CRCC PET/CT South	1440 E COUNTY LINE RD	INDIANAPOLIS	IN	Active
DSH150074BX	Child	DSH	Community Health Network, Inc.	CHVH Anticoagulation Clinic - Anti-coagulation Clinic	8075 N Shadeland Ave	Indianapolis	IN	Active
DSH150074BY	Child	DSH	Community Health Network, Inc.	CHE Multidisciplinary Clinic - Multidisciplinary Clinic	1400 N Ritter Ave	Indianapolis	IN	Active
DSH150074E	Child	DSH	Community Health Network, Inc.	COMMUNITY HEALTH NETWORK INFUSION CENTER CASTLETON	8177 CLEARVISTA PARKWAY	INDIANAPOLIS	IN	Active
DSH150074F	Child	DSH	Community Health Network, Inc.	COMMUNITY HEALTH NETWORK INFUSION CENTER EAST	7910 E Washington St. , Suite 110	INDIANAPOLIS	IN	Active
DSH150074G	Child	DSH	Community Health Network, Inc.	COMMUNITY REGIONAL CANCER CENTER SOUTH	1440 E. COUNTY LINE ROAD STE 1200	INDIANAPOLIS	IN	Active
DSH150074K	Child	DSH	Community Health Network, Inc.	COMMUNITY CANCER CARE CENTER	1629 Medical Arts Blvd, Suite 120	ANDERSON	IN	Active
DSH150074L	Child	DSH	Community Health Network, Inc.	GMHC - Hillsdale Office - Lawrence Township	6950 Hillsdale Court	Indianapolis	IN	Active
DSH150074M	Child	DSH	Community Health Network, Inc.	GMHC - Warren Township	2040 N. Shadeland Avenue, Suite 200	Indianapolis	IN	Active
DSH150074N	Child	DSH	Community Health Network, Inc.	Community Support Services	5470 East 16th Street	Indianapolis	IN	Active
DSH150074P	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Psych-social Rehab Services	1640 Ritter Avenue	Indianapolis	IN	Terminated
DSH150074Q	Child	DSH	Community Health Network, Inc.	Behavioral Health Anderson	3125 S Scatterfield Rd	Anderson	IN	Active
DSH150074R	Child	DSH	Community Health Network, Inc.	GMHC - Hancock County Office	145 Green Meadows Dr.	Greenfield	IN	Active
DSH150074S	Child	DSH	Community Health Network, Inc.	GMHC - Shelby County Office	7 E. Hendricks St.	Shelbyville	IN	Active
DSH150074T	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Family Practice Center	10122 E 10th ST STE 100	Indianapolis	IN	Terminated
DSH150074U	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	CHE Sleep/Wake Disorder Center	1400 N. Ritter Avenue STE 481	Indianapolis	IN	Terminated
DSH150074V	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Community Breast Care North	8040 Clearvista Parkway STE 290	Indianapolis	IN	Terminated
DSH150074W	Child	DSH	Community Health Network, Inc.	Community Heart and Vascular Testing Center	1400 N. Ritter Avenue Suite 500	Indianapolis	IN	Active
DSH150074X	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Community Physical Therapy and Rehab-East	7910 East Washington Street STE 150	Indianapolis	IN	Terminated
DSH150074Y	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	Community Imaging Center - East	7910 E. Washington STE 150	Indianapolis	IN	Terminated
DSH150074Z	Child	DSH	COMMUNITY HOSPITALS OF INDIANA, INC.	GMHC - @ Lutheran Child	1525 N. Ritter Avenue STE 100	Indianapolis	IN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Kiley, David President Community Hospital East 3176219337	Kiley, David President Community Hospital Indianapolis Region 3176219337	7/23/2019 10:09 AM
Contacts	Authorizing Official	Update	Change Request	Teffeteller, Scott L. President, East Region Community East Hospital 3173553390	Kiley, David President Community Hospital East 3176219337	12/4/2018 7:40 AM
Contacts	Authorizing Official	Update		Teffeteller, Scott L. President, East Region 3173553390	Teffeteller, Scott L. President, East Region Community East Hospital 3173553390	9/26/2017 1:27 PM
Contacts	Signed By	Update		Teffeteller, Scott L. President, East Region 3173553390	Teffeteller, Scott L. President, East Region Community East Hospital 3173553390	9/26/2017 1:27 PM
Contacts	Authorizing Official	Insert			Teffeteller, Scott L. President, East Region 3173553390	5/23/2017 10:34 AM
Contacts	Signed By	Insert			Teffeteller, Scott L. President, East Region 3173553390	5/23/2017 10:34 AM
Contacts	Primary Contact	Update		Cruse, David Pharmacy Director 3173555106	Hufford, Scott Pharmacy Director 3176215354	1/22/2017 3:40 PM
Addresses	Main Address	Insert			8101 Clearvista Parkway, Suite 110 Indianapolis, IN 46256	1/22/2017 3:39 PM
Dates	Last Date That 340B Drugs Purchased	Update			10/1/2014 12:00:00 AM	1/22/2017 3:39 PM
Details	State	Update		Active	Terminated	1/22/2017 3:39 PM
Terminations	Termination Comments	Update			This site never purchased 340B drugs. This termination request as a child site is based on a business decision.	1/22/2017 3:39 PM
Terminations	Termination Date	Update			4/1/2017 12:00:00 AM	1/22/2017 3:39 PM
Terminations	Termination Effective Date	Update			1/1/2017 12:00:00 AM	1/22/2017 3:39 PM
Terminations	Termination Reason	Update			DSH percentage below statutory minimum	1/22/2017 3:39 PM
Details	Last Recertification Date	Update		8/20/2015 12:00:00 AM	8/31/2016 12:00:00 AM	8/31/2016 12:07 PM
Contacts	Primary Contact	Insert			Cruse, David Pharmacy Director 3173555106	8/31/2016 12:07 PM
Details	Last Recertification Date	Update			8/20/2015 12:00:00 AM	8/20/2015 2:10 PM
Dates	Participating Approval Date	Update			9/8/2014 12:00:00 AM	9/8/2014 6:09 PM
Details	State	Update		Pending	Active	9/8/2014 6:09 PM
Dates	Start Date	Update			10/1/2014 12:00:00 AM	9/8/2014 6:09 PM
Details	340B ID	Update		DSH150074A?	DSH150074AJ	9/8/2014 5:43 PM
Details	340B ID	Update		DSH150074AF	DSH150074A?	8/29/2014 12:09 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_45859	DSH150074AF	8/22/2014 1:39 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_45859	7/15/2014 10:44 AM
Details	Last Recertification Date	Insert				7/15/2014 10:44 AM
Details	Grant Number	Insert				7/15/2014 10:44 AM
Details	340B ID	Insert				7/15/2014 10:44 AM
Details	Is Authorizing Official EHB Data	Insert				7/15/2014 10:44 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/15/2014 10:44 AM
Details	Medicare Provider Number	Insert			150074	7/15/2014 10:44 AM
Details	Entity Name	Insert			COMMUNITY HOSPITALS OF INDIANA, INC.	7/15/2014 10:44 AM
Details	Program Code	Insert			DSH	7/15/2014 10:44 AM
Details	Entity Subname	Insert			Work-Site Care Clinic -N	7/15/2014 10:44 AM
Dates	Participating Approval Date	Insert				7/15/2014 10:44 AM
Details	State	Insert			Pending	7/15/2014 10:44 AM
Dates	Registration Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 10:44 AM
Dates	Signed By Date	Insert			7/15/2014 12:00:00 AM	7/15/2014 10:44 AM
Dates	Start Date	Insert				7/15/2014 10:44 AM
Terminations	Termination Comments	Insert				7/15/2014 10:44 AM
Terminations	Termination Date	Insert				7/15/2014 10:44 AM
Terminations	Termination Effective Date	Insert				7/15/2014 10:44 AM
Terminations	Termination Reason	Insert				7/15/2014 10:44 AM