| Details | State | Update | | To Be Terminated | Terminated | 4/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 2/28/2023 12:00:00 AM | 1/30/2024 2:48 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 1/30/2024 2:48 PM |
| Terminations | Termination Comments | Update | Recertification | | Four County closed this location. | 1/30/2024 2:48 PM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2024 12:00:00 AM | 1/30/2024 2:48 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 3/1/2023 12:00:00 AM | 1/30/2024 2:48 PM |
| Terminations | Termination Reason | Update | Recertification | | Site closure | 1/30/2024 2:48 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2022 7:27:58 AM | 1/31/2023 11:59:02 AM | 1/31/2023 11:59 AM |
| Contacts | Primary Contact | Update | Recertification | Plank, Elvin
CEO
Indiana Health Centers, Inc.
3175761335-4124 | Lundy, Ann
CEO
Indiana Health Centers, Inc.
3175761335-4124 | 1/31/2023 11:53 AM |
| Details | Last Recertification Date | Update | Recertification | 2/5/2021 8:23:10 AM | 2/2/2022 7:27:58 AM | 2/2/2022 7:27 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2020 3:01:36 PM | 2/5/2021 8:23:10 AM | 2/5/2021 8:23 AM |
| Contacts | Authorizing Official | Update | AO Change Request | Lupoi, Amber
Chief Compliance Officer
Indiana Health Centers, Inc
3175761335 | Meyer, Nicole
COO
Indiana Health Centers, Inc.
3175761335-4137 | 2/4/2021 1:39 PM |
| Contacts | Authorizing Official | Update | AO Change Request | Meyer, Nicole
COO
Indiana Health Centers, Inc.
3175761335-4137 | Lupoi, Amber
Chief Compliance Officer
Indiana Health Centers, Inc
3175761335 | 5/1/2020 3:30 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Meyer, Nicole
Coo
Indiana Health Centers, Inc.
3175761335-4137 | Meyer, Nicole
COO
Indiana Health Centers, Inc.
3175761335-4137 | 2/3/2020 3:04 PM |
| Contacts | Signed By | Update | Profile Change Request | Meyer, Nicole
Coo
Indiana Health Centers, Inc.
3175761335-4137 | Meyer, Nicole
COO
Indiana Health Centers, Inc.
3175761335-4137 | 2/3/2020 3:04 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | Meyer, Nicole
Coo
Indiana Health Centers, Inc.
3175761335-4137 | 2/3/2020 3:04 PM |
| Contacts | Signed By | Update | Profile Change Request | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | Meyer, Nicole
Coo
Indiana Health Centers, Inc.
3175761335-4137 | 2/3/2020 3:04 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 9:47:25 AM | 2/3/2020 3:01:36 PM | 2/3/2020 3:01 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2018 4:11:02 PM | 1/29/2019 9:47:25 AM | 1/29/2019 9:47 AM |
| Contacts | Primary Contact | Update | Recertification | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | Plank, Elvin
CEO
Indiana Health Centers, Inc.
3175761335-4124 | 2/12/2018 4:11 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/12/2018 4:11:02 PM | 2/12/2018 4:11 PM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/12/2018 4:11 PM |
| Contacts | Authorizing Official | Update | | Meyer, Nicole
CCQO
3175761335-4137 | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | 2/12/2018 3:57 PM |
| Contacts | Primary Contact | Update | | Meyer, Nicole
CCQO
3175761335-4137 | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | 2/12/2018 3:57 PM |
| Contacts | Signed By | Update | | Meyer, Nicole
CCQO
3175761335-4137 | Meyer, Nicole
CCQO
Indiana Health Centers, Inc.
3175761335-4137 | 2/12/2018 3:57 PM |
| Contacts | Authorizing Official | Insert | | | Meyer, Nicole
CCQO
3175761335-4137 | 5/15/2017 2:51 PM |
| Contacts | Primary Contact | Insert | | | Meyer, Nicole
CCQO
3175761335-4137 | 5/15/2017 2:51 PM |
| Contacts | Signed By | Insert | | | Meyer, Nicole
CCQO
3175761335-4137 | 5/15/2017 2:51 PM |
| Addresses | Main Address | Insert | | |
421 12th Street
Logansport, IN 46947-3539 | 5/15/2017 2:44 PM |
| Dates | Participating Approval Date | Update | | | 5/15/2017 12:00:00 AM | 5/15/2017 2:43 PM |
| Details | State | Update | | Pending | Active | 5/15/2017 2:43 PM |
| Dates | Start Date | Update | | | 7/1/2017 12:00:00 AM | 5/15/2017 2:43 PM |
| Details | 340B ID | Update | | ONLINE_REG_76438 | CH05311S | 5/12/2017 2:25 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_76438 | 4/11/2017 9:36 AM |
| Details | Last Recertification Date | Insert | | | | 4/11/2017 9:36 AM |
| Details | Grant Number | Insert | | | H80CS00668 | 4/11/2017 9:36 AM |
| Details | 340B ID | Insert | | | ONLINE_REG | 4/11/2017 9:36 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 4/11/2017 9:36 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/11/2017 9:36 AM |
| Details | Medicare Provider Number | Insert | | | | 4/11/2017 9:36 AM |
| Details | Entity Name | Insert | | | INDIANA HEALTH CENTERS INCORPORATED | 4/11/2017 9:36 AM |
| Details | Program Code | Insert | | | CH | 4/11/2017 9:36 AM |
| Details | Entity Subname | Insert | | | IHC at Four County | 4/11/2017 9:36 AM |
| Dates | Participating Approval Date | Insert | | | | 4/11/2017 9:36 AM |
| Details | State | Insert | | | Pending | 4/11/2017 9:36 AM |
| Dates | Registration Date | Insert | | | 4/11/2017 12:00:00 AM | 4/11/2017 9:36 AM |
| Dates | Signed By Date | Insert | | | 4/11/2017 12:00:00 AM | 4/11/2017 9:36 AM |
| Dates | Start Date | Insert | | | | 4/11/2017 9:36 AM |
| Terminations | Termination Comments | Insert | | | | 4/11/2017 9:36 AM |
| Terminations | Termination Date | Insert | | | | 4/11/2017 9:36 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/11/2017 9:36 AM |
| Terminations | Termination Reason | Insert | | | | 4/11/2017 9:36 AM |