Covered Entity Details

DSH150051Q IU HEALTH BLOOMINGTON HOSPITAL (Terminated) - information as of 6/6/2025 12:40:49 PM

Main Details

Name

IU HEALTH BLOOMINGTON HOSPITAL

Subdivision Name

PHYSICAL THERAPY - RSMC Outpatient

Type

Disproportionate Share Hospital

Rural

340B ID

DSH150051Q

Medicare Provider Number

150051

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/17/2018

Participating Start Date

10/1/2018

Participating Approval Date

7/19/2018

Last Recertification Date

8/20/2019

Termination Date
Termination Reason

4/1/2020
Other

Contacts

Authorizing Official

Indiana University Health
Jennifer M. Alvey, SVP & CFO
(317) 963-0213

Primary Contact

IU Health, Inc.
Jennifer Ann Hatchett, Senior Financial Analyst
(317) 962-4243

Addresses

Street Address

9149 State Road 37
Bedford, IN 47421

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
DSH150051A	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH ANTICOAGULATION CENTER	727 West Second Street	BLOOMINGTON	IN	Terminated
DSH150051B	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH PEDIATRIC DIAGNOSTIC TESTING CENTER	4935 W ARLINGTON RD D	BLOOMINGTON	IN	Terminated
DSH150051C	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH CANCER CENTER INFUSION THERAPY	508 W 2ND ST	BLOOMINGTON	IN	Terminated
DSH150051D	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	I U HEALTH CHILDRENS THERAPY CENTER	4935 W ARLINGTON RD B	BLOOMINGTON	IN	Terminated
DSH150051E	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH WOUND CENTER	2920 S MCINTIRE DR 103	BLOOMINGTON	IN	Terminated
DSH150051F	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH REHABILITATION AND SPORTS	2499 W COTA DR	BLOOMINGTON	IN	Terminated
DSH150051G	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH REHABILITATION AND SPORTS	328 S WOODSCREST DR	BLOOMINGTON	IN	Terminated
DSH150051H	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH REHABILITATION AND SPORTS	926 W State Road 46, Suite 200	SPENCER	IN	Terminated
DSH150051J	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH PAIN CENTER	888 S AUTO MALL RD	BLOOMINGTON	IN	Active
DSH150051K	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH DIABETES CENTER	727 W 2ND ST	BLOOMINGTON	IN	Terminated
DSH150051L	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH CANCER RADIATION CENTER	9149 STATE ROAD 37	BEDFORD	IN	Terminated
DSH150051M	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH CANCER RADIATION CENTER	2620 W COTA DR	BLOOMINGTON	IN	Active
DSH150051N	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH BEHAVIORAL HEALTH	727 W. 2nd Street	BLOOMINGTON	IN	Active
DSH150051P	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU HEALTH CHEST PAIN CENTER	714 S ROGERS ST	BLOOMINGTON	IN	Terminated
DSH150051Q	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	PHYSICAL THERAPY - RSMC Outpatient	9149 State Road 37	Bedford	IN	Terminated
DSH150051R	Child	DSH	IU HEALTH BLOOMINGTON HOSPITAL	IU Health Cancer Services - OP Oncology Infusion Center	514 W. 2nd Street	Bloomington	IN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/5/2020 12:00:00 AM	2/6/2020 12:59 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/6/2020 12:59 PM
Terminations	Termination Comments	Update	Termination Request		Site still eligible. Currently not in use.	2/6/2020 12:59 PM
Terminations	Termination Date	Update	Termination Request		4/1/2020 12:00:00 AM	2/6/2020 12:59 PM
Terminations	Termination Effective Date	Update	Termination Request		2/5/2020 12:00:00 AM	2/6/2020 12:59 PM
Terminations	Termination Reason	Update	Termination Request		Other	2/6/2020 12:59 PM
Addresses	Main Address	Update	Change Request	2620 Cota Drive Bloomington, IN 47403	9149 State Road 37 Bedford, IN 47421	1/17/2020 8:47 AM
Details	Last Recertification Date	Update	Recertification		8/20/2019 2:18:57 PM	8/20/2019 2:18 PM
Contacts	Primary Contact	Update	Change Request	Bradley, Caroline Drum Program Director IU Health 3179631628	Hatchett, Jennifer Ann Senior Financial Analyst IU Health, Inc. 3179624243	6/25/2019 10:24 AM
Contacts	Primary Contact	Update	Change Request	Davies, Don Manager of 340B/Audit Indiana University Health, Inc. 3179632580	Bradley, Caroline Drum Program Director IU Health 3179631628	10/12/2018 1:35 PM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Contacts	Signed By	Insert	New Registration		Alvey, Jennifer M. SVP & CFO Indiana University Health 3179630213	7/19/2018 7:05 AM
Details	340B ID	Update	New Registration		DSH150051Q	7/19/2018 7:05 AM
Details	Entity Subname	Update	New Registration	PHYSICAL THERAPY	PHYSICAL THERAPY - RSMC Outpatient	7/19/2018 7:05 AM
Dates	Participating Approval Date	Update	New Registration		7/19/2018 7:05:18 AM	7/19/2018 7:05 AM
Details	State	Update	New Registration	Pending	Approved	7/19/2018 7:05 AM
Dates	Signed By Date	Update	New Registration		7/17/2018 3:20:45 PM	7/19/2018 7:05 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	7/19/2018 7:05 AM
Addresses	Main Address	Insert	New Registration		2620 Cota Drive Bloomington, IN 47403	7/17/2018 10:57 AM
Contacts	Authorizing Official	Insert	New Registration		Alvey, Jennifer M. SVP & CFO Indiana University Health 3179630213	7/17/2018 10:57 AM
Contacts	Primary Contact	Insert	New Registration		Davies, Don Manager of 340B/Audit Indiana University Health, Inc. 3179632580	7/17/2018 10:57 AM
Details	Last Recertification Date	Insert	New Registration			7/17/2018 10:57 AM
Details	Grant Number	Insert	New Registration			7/17/2018 10:57 AM
Details	340B ID	Insert	New Registration			7/17/2018 10:57 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/17/2018 10:57 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/17/2018 10:57 AM
Details	Medicare Provider Number	Insert	New Registration		150051	7/17/2018 10:57 AM
Details	Entity Name	Insert	New Registration		IU HEALTH BLOOMINGTON HOSPITAL	7/17/2018 10:57 AM
Details	Program Code	Insert	New Registration		DSH	7/17/2018 10:57 AM
Details	Entity Subname	Insert	New Registration		PHYSICAL THERAPY	7/17/2018 10:57 AM
Dates	Participating Approval Date	Insert	New Registration			7/17/2018 10:57 AM
Details	State	Insert	New Registration		Pending	7/17/2018 10:57 AM
Dates	Registration Date	Insert	New Registration		7/17/2018 10:57:12 AM	7/17/2018 10:57 AM
Dates	Signed By Date	Insert	New Registration			7/17/2018 10:57 AM
Dates	Start Date	Insert	New Registration			7/17/2018 10:57 AM
Terminations	Termination Comments	Insert	New Registration			7/17/2018 10:57 AM
Terminations	Termination Date	Insert	New Registration			7/17/2018 10:57 AM
Terminations	Termination Effective Date	Insert	New Registration			7/17/2018 10:57 AM
Terminations	Termination Reason	Insert	New Registration			7/17/2018 10:57 AM