Covered Entity Details

CH05311X INDIANA HEALTH CENTERS INCORPORATED (Active) - information as of 6/16/2025 12:59:48 AM

Main Details

Name

INDIANA HEALTH CENTERS INCORPORATED

Subdivision Name

IHC-Owen County

Type

HRSA-Funded Health Center

Site ID

BPS-H80-019007

340B ID

CH05311X

Grant Number

H80CS00668

Additional Details

Current Program Status

Active

Registration Date

4/5/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/6/2018

Last Recertification Date

2/18/2025

Contacts

Authorizing Official

Indiana Health Centers, Inc.
Nicole Meyer, COO
(317) 576-1335 Ext: 4137

Primary Contact

Indiana Health Centers, Inc.
Ann Lundy, CEO
(317) 576-1335

Addresses

Street Address

35 Bobs Babb Drive
Spencer, IN 47460

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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
Contract Detail	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06739	860 WEST MORGAN STREET	SPENCER	IN	47460	01/05/2024	04/01/2024			04/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH053110	Active	BPS-H80-004031	INDIANA HEALTH CENTERS INCORPORATED	INDIANA HEALTH CENTERS, INC.	8003 Castleway Dr	Indianapolis	IN
CH05311A	Active	BPS-H80-004926	INDIANA HEALTH CENTERS INCORPORATED	IHC @ Kokomo & WIC Program	3118 S Lafountain St	Kokomo	IN
CH05311B	Active	BPS-H80-003393	INDIANA HEALTH CENTERS INCORPORATED	INDIANA HLTH CTR AT MARION	925 S Nebraska St	Marion	IN
CH05311G	Active	BPS-H80-027158	INDIANA HEALTH CENTERS INCORPORATED	IHC Michigan Street	765 South Michigan Street	SOUTH BEND	IN
CH05311H	Active	BPS-H80-001232	INDIANA HEALTH CENTERS INCORPORATED	Indiana Health Center @ South Bend	1901 WEST WESTERN AVE STE B	SOUTH BEND	IN
CH05311I	Terminated	BPS-H80-000912	INDIANA HEALTH CENTERS INCORPORATED	COMMUNITY HLTH CENTER OF JACKSON COUNTY	113 N Chestnut St	Seymour	IN
CH05311N	Active	BPS-H80-002846	INDIANA HEALTH CENTERS INCORPORATED	CASS COUNTY CHC & WIC Program	1700 Dividend Dr	Logansport	IN
CH05311P	Active	BPS-H80-013408	INDIANA HEALTH CENTERS INCORPORATED	Community Health Center of Miami County	661 E Main St	Peru	IN
CH05311Q	Active	BPS-H80-014914	INDIANA HEALTH CENTERS INCORPORATED	IHC Bendix Community Health Center	1010 N BENDIX DR	SOUTH BEND	IN
CH05311R	Active	BPS-H80-017417	INDIANA HEALTH CENTERS INCORPORATED	CHCJC Annex	120 Saint Louis Avenue	Seymour	IN
CH05311S	Terminated	BPS-H80-019045	INDIANA HEALTH CENTERS INCORPORATED	IHC at Four County	421 12th Street	Logansport	IN
CH05311T	Active	BPS-H80-014002	INDIANA HEALTH CENTERS INCORPORATED	Grant-Blackford Community Support Program facility	206 W 8TH ST	MARION	IN
CH05311U	Active	BPS-H80-013786	INDIANA HEALTH CENTERS INCORPORATED	Oaklawn Psychiatric Center	415 E MADISON ST	SOUTH BEND	IN
CH05311V	Terminated	BPS-H80-006932	INDIANA HEALTH CENTERS INCORPORATED	Project Homecoming at YWCA Facility	802 N LAFAYETTE BLVD	SOUTH BEND	IN
CH05311W	Active	BPS-H80-006212	INDIANA HEALTH CENTERS INCORPORATED	HealthQuest Van	HEALTHQUEST VAN 925 SOUTH	MARION	IN
CH05311X	Active	BPS-H80-019007	INDIANA HEALTH CENTERS INCORPORATED	IHC-Owen County	35 Bobs Babb Drive	Spencer	IN
CH05311Y	Active	BPS-H80-036048	INDIANA HEALTH CENTERS	IHC Bedford	2415 Mitchell Road STE C	Bedford	IN

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH053110	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/01/2024
CH053110	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/01/2024
CH053110	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/01/2024
CH053110	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/01/2024
CH053110	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/01/2024
CH053110	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/01/2024
CH053110	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/01/2024
CH053110	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/01/2024
CH053110	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/01/2024
CH053110	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/01/2024
CH053110	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/01/2024
CH053110	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/01/2024
CH053110	GENOA HEALTHCARE LLC	800 FULTON STREET SUITE 102		LOGANSPORT	IN	46947	10/01/2023
CH053110	GENOA HEALTHCARE LLC	505 N WABASH AVE RM 106		MARION	IN	46952	10/01/2023
CH053110	GENOA HEALTHCARE LLC	322 N. MAIN, RM 134		KOKOMO	IN	46901-4622	10/01/2023
CH053110	GENOA HEALTHCARE LLC	415 E MADISON ST STE 200		SOUTH BEND	IN	46617	10/01/2023
CH053110	GENOA HEALTHCARE LLC	720 NORTH MARR ROAD		COLUMBUS	IN	47201-6660	10/01/2023	04/01/2024
CH053110	GENOA HEALTHCARE LLC	645 SOUTH ROGERS STREET		BLOOMINGTON	IN	47403-2353	10/01/2023
CH05311U	GENOA HEALTHCARE LLC	415 E MADISON ST STE 200		SOUTH BEND	IN	46617	07/01/2024
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02484	4630 SO. WASHINGTON ST.	MARION	IN	46953	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 02941	610 W. MARKLAND AVE.	KOKOMO	IN	46901	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06463	2210 E. EDISON	SOUTH BEND	IN	46615	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06464	210 N. MAIN ST.	MISHAWAKA	IN	46544	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06487	2101 EAST IRELAND RD.	SOUTH BEND	IN	46614	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06513	486 N. CASS ST.,	WABASH	IN	46992	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06531	3404 EAST MARKET ST	LOGANSPORT	IN	46947	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06534	717 NORTH 3RD STREET	LOGANSPORT	IN	46947	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06536	2340 W SYCAMORE	KOKOMO	IN	46901	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06542	4026 S 00 EW	KOKOMO	IN	46902	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06545	2 SOUTH BROADWAY	PERU	IN	46970	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06621	415 W. 3RD ST.	MARION	IN	46952	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY #06622	1700 N. WALNUT ST	HARTFORD CITY	IN	47348	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06626	301 E. MAIN ST.	GAS CITY	IN	46933	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06696	415 S. MAIN ST.	BROWNSTOWN	IN	47220	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06739	860 WEST MORGAN STREET	SPENCER	IN	47460	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06756	201 EAST TIPTON STREET	SEYMOUR	IN	47274	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06780	815 W. MCCLAIN ST.	SCOTTSBURG	IN	47170	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08631	4403 W. WESTERN AVE.	SOUTH BEND	IN	46619	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08642	2051 SOUTH BEND AVENUE	SOUTH BEND	IN	46637	10/01/2022
CH053110	HOOK-SUPERX, L.L.C.	CVS PHARMACY # 16029	1037 S REED RD	KOKOMO	IN	46902	10/01/2022
CH05311A	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06536	2340 W SYCAMORE	KOKOMO	IN	46901	04/01/2024
CH05311B	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06621	415 W. 3RD ST.	MARION	IN	46952	04/01/2024
CH05311G	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08631	4403 W. WESTERN AVE.	SOUTH BEND	IN	46619	04/01/2024	04/01/2024
CH05311H	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08631	4403 W. WESTERN AVE.	SOUTH BEND	IN	46619	04/01/2024
CH05311N	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06534	717 NORTH 3RD STREET	LOGANSPORT	IN	46947	04/01/2024	04/01/2024
CH05311P	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06545	2 SOUTH BROADWAY	PERU	IN	46970	04/01/2024
CH05311Q	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08631	4403 W. WESTERN AVE.	SOUTH BEND	IN	46619	04/01/2024	04/01/2024
CH05311R	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06756	201 EAST TIPTON STREET	SEYMOUR	IN	47274	04/01/2024
CH05311U	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 08631	4403 W. WESTERN AVE.	SOUTH BEND	IN	46619	04/01/2024	04/01/2024
CH05311T	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06621	415 W. 3RD ST.	MARION	IN	46952	04/01/2024	04/01/2024
CH05311W	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06621	415 W. 3RD ST.	MARION	IN	46952	04/01/2024	04/01/2024
CH05311X	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06739	860 WEST MORGAN STREET	SPENCER	IN	47460	04/01/2024
CH05311Q	HOOK-SUPERX, L.L.C.	DBA: CVS/PHARMACY # 06463	2210 E. EDISON	SOUTH BEND	IN	46615	07/01/2024
CH053110	KROGER COLUMBUS CENTRAL FILL #019	2270 RICKENBACKER PKWY W		COLUMBUS	OH	43217	10/01/2023
CH053110	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2023
CH053110	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	01/01/2025
CH053110	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2023
CH053110	OWEN'S PHARMACY J-841	2718 GUILFORD ST		HUNTINGTON	IN	46750	10/01/2023
CH053110	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/01/2024
CH053110	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/01/2024
CH053110	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/01/2024
CH053110	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2023
CH053110	WAL-MART PHARMACY 10-0922	2363 HWY 135 NW		CORYDON	IN	47112	10/01/2023
CH053110	WAL-MART PHARMACY 10-0996	823 WEST STATE HIGHWAY 46		SPENCER	IN	47460	10/01/2023
CH053110	WAL-MART PHARMACY 10-1033	1600 E TIPTON ST		SEYMOUR	IN	47274	10/01/2023
CH05311Y	WAL-MART PHARMACY 10-1033	1600 E TIPTON ST		SEYMOUR	IN	47274	07/01/2024
CH053110	WAL-MART PHARMACY 10-1294	3240 SOUTH WESTERN		MARION	IN	46952	10/01/2023
CH05311T	WAL-MART PHARMACY 10-1294	3240 SOUTH WESTERN		MARION	IN	46952	07/01/2024
CH053110	WAL-MART PHARMACY 10-1329	240 MALL RD		LOGANSPORT	IN	46947	10/01/2023
CH05311N	WAL-MART PHARMACY 10-1329	240 MALL RD		LOGANSPORT	IN	46947	07/01/2024
CH053110	WAL-MART PHARMACY 10-1962	1920 E. MARKLAND AVE		KOKOMO	IN	46901	10/01/2023
CH05311W	WAL-MART PHARMACY 10-1962	1920 E. MARKLAND AVE		KOKOMO	IN	46901	07/01/2024
CH053110	WAL-MART PHARMACY 10-2563	735 NORTH GOSPEL ST		PAOLI	IN	47454	10/01/2023
CH053110	WAL-MART PHARMACY 10-2680	3701 PORTAGE ROAD		SOUTH BEND (N)	IN	46628	10/01/2023
CH053110	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2023
CH053110	WALGREEN CO	DBA: WALGREENS #10073	2400 W SYCAMORE STREET	KOKOMO	IN	46901	10/24/2012
CH053110	WALGREEN CO	DBA: WALGREENS #11454	319 E TIPTON STREET	SEYMOUR	IN	47274	10/24/2012
CH053110	WALGREEN CO	DBA: WALGREENS SPECIALTY PHARMACY #12470	330 N WABASH AVENUE STE 100	MARION	IN	46952	04/01/2017
CH053110	WALGREEN CO.	DBA: WALGREENS # 03437	1010 E IRELAND RD	SOUTH BEND	IN	46614	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 05663	1323 N BALDWIN AVE	MARION	IN	46952	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 10184	1351 N IRONWOOD DR	SOUTH BEND	IN	46615-3566	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 12344	1945 LINCOLNWAY E.	SOUTH BEND	IN	46613	10/24/2012	11/07/2019
CH053110	WALGREEN CO.	DBA: WALGREENS # 03148	2301 E. MARKET STREET	LOGANSPORT	IN	46947	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 10074	2345 E MARKLAND AVE	KOKOMO	IN	46901-6245	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 03524	2400 BEAM ROAD	COLUMBUS	IN	47203	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 09279	2620 S WESTERN AVE	MARION	IN	46953-3556	10/24/2012	10/11/2023
CH053110	WALGREEN CO.	DBA: WALGREENS # 09220	2845 W CLEVELAND RD	SOUTH BEND	IN	46628	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 06944	3608 S LAFOUNTAIN STREET	KOKOMO	IN	46902-3809	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS #12585	4444 W. WESTERN AVENUE	SOUTH BEND	IN	46619	10/24/2012	11/07/2019
CH053110	WALGREEN CO.	DBA: WALGREENS # 11085	52482 INDIANA STATE RTE 933	SOUTH BEND	IN	46637-3852	10/24/2012
CH053110	WALGREEN CO.	DBA: WALGREENS # 09826	9 N STATE ST	NORTH VERNON	IN	47265-1723	10/24/2012	03/25/2025
CH053110	WALGREEN CO.	DBA: WALGREENS # 09827	720 N BROADWAY	PERU	IN	46970-1027	10/01/2013
CH05311G	WALGREEN CO.	DBA: WALGREENS # 03437	1010 E IRELAND RD	SOUTH BEND	IN	46614	07/01/2024
CH053110	Walgreens Central Fill #21399	4132Plainfield Rd	Ste 110	Indianapolis	IN	46231-7021	04/01/2023
CH053110	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023
CH053110	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	1/29/2024 8:02:00 AM	2/18/2025 8:10:50 AM	2/18/2025 8:10 AM
Details	Last Recertification Date	Update	Recertification	1/31/2023 11:56:12 AM	1/29/2024 8:02:00 AM	1/29/2024 8:02 AM
Details	Last Recertification Date	Update	Recertification	2/2/2022 7:35:44 AM	1/31/2023 11:56:12 AM	1/31/2023 11:56 AM
Contacts	Primary Contact	Update	Change Request	Plank, Elvin CEO Indiana Health Centers, Inc. 3175761335-4124	Lundy, Ann CEO Indiana Health Centers, Inc. 3175761335	7/15/2022 11:24 AM
Details	Last Recertification Date	Update	Recertification	2/5/2021 8:21:53 AM	2/2/2022 7:35:44 AM	2/2/2022 7:35 AM
Details	Last Recertification Date	Update	Recertification	2/3/2020 3:03:13 PM	2/5/2021 8:21:53 AM	2/5/2021 8:21 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 3:29 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 9:42:39 AM	2/3/2020 3:03:13 PM	2/3/2020 3:03 PM
Details	Last Recertification Date	Update	Recertification		1/29/2019 9:42:39 AM	1/29/2019 9:42 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Meyer, Nicole CCQO Indiana Health Centers, Inc. 3175761335-4137	4/6/2018 8:00 AM
Details	340B ID	Update	New Registration		CH05311X	4/6/2018 8:00 AM
Dates	Participating Approval Date	Update	New Registration		4/6/2018 8:00:21 AM	4/6/2018 8:00 AM
Details	State	Update	New Registration	Pending	Approved	4/6/2018 8:00 AM
Dates	Signed By Date	Update	New Registration		4/5/2018 1:29:15 PM	4/6/2018 8:00 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/6/2018 8:00 AM
Addresses	Main Address	Insert	New Registration		35 Bobs Babb Drive Spencer, IN 47460	4/5/2018 12:18 PM
Contacts	Primary Contact	Insert	New Registration		Plank, Elvin CEO Indiana Health Centers, Inc. 3175761335-4124	4/5/2018 12:18 PM
Contacts	Authorizing Official	Insert	New Registration		Meyer, Nicole CCQO Indiana Health Centers, Inc. 3175761335-4137	4/5/2018 12:18 PM
Details	Last Recertification Date	Insert	New Registration			4/5/2018 12:18 PM
Details	Grant Number	Insert	New Registration		H80CS00668	4/5/2018 12:18 PM
Details	340B ID	Insert	New Registration			4/5/2018 12:18 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/5/2018 12:18 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/5/2018 12:18 PM
Details	Medicare Provider Number	Insert	New Registration			4/5/2018 12:18 PM
Details	Entity Name	Insert	New Registration		INDIANA HEALTH CENTERS INCORPORATED	4/5/2018 12:18 PM
Details	Program Code	Insert	New Registration		CH	4/5/2018 12:18 PM
Details	Entity Subname	Insert	New Registration		IHC-Owen County	4/5/2018 12:18 PM
Dates	Participating Approval Date	Insert	New Registration			4/5/2018 12:18 PM
Details	State	Insert	New Registration		Pending	4/5/2018 12:18 PM
Dates	Registration Date	Insert	New Registration		4/5/2018 12:18:38 PM	4/5/2018 12:18 PM
Dates	Signed By Date	Insert	New Registration			4/5/2018 12:18 PM
Dates	Start Date	Insert	New Registration			4/5/2018 12:18 PM
Terminations	Termination Comments	Insert	New Registration			4/5/2018 12:18 PM
Terminations	Termination Date	Insert	New Registration			4/5/2018 12:18 PM
Terminations	Termination Effective Date	Insert	New Registration			4/5/2018 12:18 PM
Terminations	Termination Reason	Insert	New Registration			4/5/2018 12:18 PM

340B Drug Pricing Program Database