| Addresses | Shipping Address | Insert | Change Request | | IU HEALTH BLOOMINGTON INPATIENT PHARMACY
2651 EAST DISCOVERY PARKWAY
Bloomington, IN 47408 | 5/27/2025 11:10 AM |
| Details | Last Recertification Date | Update | Recertification | 8/22/2023 2:15:49 PM | 8/12/2024 3:18:35 PM | 8/12/2024 3:18 PM |
| Addresses | Shipping Address | Insert | Change Request | | Indiana University Health Inc. d/b/a IU Health Shared Services Pharmacy
390 Airtech Parkway
Suite106B
Plainfield, IN 46168 | 3/12/2024 7:54 AM |
| Details | Last Recertification Date | Update | Recertification | 9/5/2022 9:21:53 AM | 8/22/2023 2:15:49 PM | 8/22/2023 2:15 PM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2021 1:06:57 PM | 9/5/2022 9:21:53 AM | 9/5/2022 9:21 AM |
| Addresses | Shipping Address | Update | Change Request | IU HEALTH BLOOMINGTON RETAIL PHARMACY
601 W 2ND ST STE 100
BLOOMINGTON, IN 47403-2317 | IU HEALTH BLOOMINGTON RETAIL PHARMACY
2651 EAST DISCOVERY PARKWAY
RM A2032
BLOOMINGTON, IN 47408 | 12/8/2021 3:04 PM |
| Addresses | Main Address | Update | Change Request |
601 WEST SECOND STREET
BLOOMINGTON, IN 47403 |
2651 EAST DISCOVERY PARKWAY
BLOOMINGTON, IN 47408 | 12/8/2021 3:04 PM |
| Details | Last Recertification Date | Update | Recertification | 9/3/2020 3:06:25 PM | 8/17/2021 1:06:57 PM | 8/17/2021 1:06 PM |
| Details | Last Recertification Date | Update | Recertification | 8/21/2019 9:34:39 PM | 9/3/2020 3:06:25 PM | 9/3/2020 3:06 PM |
| Addresses | Shipping Address | Insert | Change Request | | IU HEALTH BLOOMINGTON RETAIL PHARMACY
601 W 2ND ST STE 100
BLOOMINGTON, IN 47403-2317 | 12/20/2019 10:26 AM |
| Details | Last Recertification Date | Update | Recertification | 9/6/2018 2:33:17 PM | 8/21/2019 9:34:39 PM | 8/21/2019 9:34 PM |
| Contacts | Primary Contact | Update | Recertification | Davies, Don
Manager of 340B/Audit
Indiana University Health, Inc.
3179632580 | Hatchett, Jennifer Ann
Senior Financial Analyst
IU Health, Inc.
3179624243 | 9/6/2018 2:33 PM |
| Details | Last Recertification Date | Update | Recertification | 12/6/2017 12:48:17 PM | 9/6/2018 2:33:17 PM | 9/6/2018 2:33 PM |
| Details | Last Recertification Date | Update | Recertification | | 12/6/2017 12:48:17 PM | 12/6/2017 12:48 PM |
| Contacts | Primary Contact | Update | Change Request | Melby, Michael
Regional Director of Pharmacy
8123539199 | Davies, Don
Manager of 340B/Audit
Indiana University Health, Inc.
3179632580 | 10/12/2017 11:26 AM |
| Contacts | Authorizing Official | Update | | Alvey, Jennifer M.
SVP & CFO
3179630213 | Alvey, Jennifer M.
SVP & CFO
Indiana University Health
3179630213 | 10/12/2017 11:10 AM |
| Contacts | Authorizing Official | Insert | | | Alvey, Jennifer M.
SVP & CFO
3179630213 | 8/1/2017 2:26 PM |
| Contacts | Signed By | Insert | | | Craig, Michael L.
Chief Financial Officer
8123539554 | 5/23/2017 10:34 AM |
| Addresses | Main Address | Insert | | |
601 WEST SECOND STREET
BLOOMINGTON, IN 47403 | 5/23/2017 10:12 AM |
| Contacts | Primary Contact | Insert | | | Melby, Michael
Regional Director of Pharmacy
8123539199 | 11/4/2016 3:06 PM |
| Dates | Participating Approval Date | Update | | | 8/23/2016 12:00:00 AM | 8/23/2016 4:35 PM |
| Details | State | Update | | Pending | Active | 8/23/2016 4:35 PM |
| Dates | Start Date | Update | | | 10/1/2016 12:00:00 AM | 8/23/2016 4:35 PM |
| Details | Comments Public | Insert | | | 8/23/16 Participated as an RRC starting 4/1/2011, converting to a DSH EFFECTIVE 10/1/2016 | 8/23/2016 4:35 PM |
| Details | Comments Public | Insert | | | Participated as an RRC starting 4/1/2011, converting to a DSH 10/1/2016. | 8/23/2016 8:20 AM |
| Details | 340B ID | Update | | ONLINE_REG_71008 | DSH150051 | 7/7/2016 1:19 PM |
| Details | 340B ID | Update | | | ONLINE_REG_71008 | 7/6/2016 12:58 PM |
| Details | Last Recertification Date | Insert | | | | 7/6/2016 12:58 PM |
| Details | Grant Number | Insert | | | | 7/6/2016 12:58 PM |
| Details | 340B ID | Insert | | | | 7/6/2016 12:58 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/6/2016 12:58 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/6/2016 12:58 PM |
| Details | Medicare Provider Number | Insert | | | 150051 | 7/6/2016 12:58 PM |
| Details | Entity Name | Insert | | | IU HEALTH BLOOMINGTON HOSPITAL | 7/6/2016 12:58 PM |
| Details | Program Code | Insert | | | DSH | 7/6/2016 12:58 PM |
| Details | Entity Subname | Insert | | | | 7/6/2016 12:58 PM |
| Dates | Participating Approval Date | Insert | | | | 7/6/2016 12:58 PM |
| Details | State | Insert | | | Pending | 7/6/2016 12:58 PM |
| Dates | Registration Date | Insert | | | 7/6/2016 12:00:00 AM | 7/6/2016 12:58 PM |
| Dates | Signed By Date | Insert | | | 7/6/2016 12:00:00 AM | 7/6/2016 12:58 PM |
| Dates | Start Date | Insert | | | | 7/6/2016 12:58 PM |
| Terminations | Termination Comments | Insert | | | | 7/6/2016 12:58 PM |
| Terminations | Termination Date | Insert | | | | 7/6/2016 12:58 PM |
| Terminations | Termination Effective Date | Insert | | | | 7/6/2016 12:58 PM |
| Terminations | Termination Reason | Insert | | | | 7/6/2016 12:58 PM |