340B Drug Pricing Program Database


CHC26567-32 Meridian Health Services Corp. (Active) - information as of 4/28/2025 12:42:19 AM

Main Details
Meridian Health Services Corp.
Meridian Health Services Corp
HRSA-Funded Health Center
BPS-H80-035549
CHC26567-32
H80CS26567


Additional Details
Active
5/2/2023
7/1/2023
5/4/2023
2/18/2025

Contacts

Meridian Health Services
Scott Riggs, Chief Financial Officer
(765) 254-5189

Meridian Health Services -
Amy Thomas, 340B Program Coordinator
(765) 313-6533

Addresses

1026 S Main St STE 1
Bluffton, IN 46714-3614

Meridian Health Services Corp.
240 N Tillotson Ave
Muncie, IN 47304


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IN300067120,300077930,300081080,201385970,100348680,201356490,300067829,300020592,200872630,300035201,300034813,300082509,300079745,300026493,300073496,300040615,200295740,300002674,300035572,201236000,300029569,201073600,200866820,300053401,200263520,201228780,300029148,200423680,300054327,300079665,300061399,300051529,200376490,300083290,300057492,200375810,300086884,200319580,201227030,300039604,300064323,201228400,201000550,201354500,300026936,300037773,200281630,201293370,100098070,201318570,300065096,200176010,300021732,200980090,300030139,300072607,300032902,200126480,300036809,200198920,300082800,201033550,100330180,300080209,201028800,300080907,200958640,300081670,100366080,201040610,201094120,300086014,300081323,300008451,200524010,300027474,100115020,300082060,300018880,200028436,200108480,200961160,300084005,300068415,300068341,300043715,201002830,300082857,300084543,300031406,300079162,300079260,201098630,201003400,300013488,300022048,300082674,100232330,300085810,3000813071528706785,1316658248,1760193692,1992748339,1619935475,1841545282,1184355869,1588147755,1699822320,1396196556,1730722125,1528846474,1255010732,1275874489,1588361463,1447888474,1285686329,1497293377,1851653588,1730509605,1194278507,1427212398,1316982309,1164955936,1659361483,1063739670,1982167706,1356325484,1023634318,1699452649,1487206041,1578107637,1487600235,1689362691,1144819764,1205983855,1225010358,1194784603,1871873711,1154842813,1932606001,1962782805,1629286141,1104239516,1477994291,1083241012,1831139666,1407146004,1669467932,1770969339,1669117370,1578507539,1609395425,1932220035,1922108414,1659086734,1033405626,1598721128,1104188754,1083655427,1548945389,1336276823,1871569772,1033891601,1316101363,1700563913,1376717744,1366220907,1104803212,1710262308,1649529348,1700658952,1497534200,1104345420,1952313314,1437612272,1144216060,1639957681,1134601552,1609259001,1801878947,1952566572,1003696139,1720548621,1154046811,1346847886,1346541786,1386325587,1881468452,1194700179,1952718231,1598245037,1720692494,1396075487,1356486286,1629485107,1447731302,1336927300,1861429714,1639755739,1700650785,1700569423
Shipping Addresses

Meridian Health Services
1026 S Main St
STE 1
Bluffton, IN 46714

Meridian Health Rx -- Anderson
1547 Ohio Ave
Suite A
Anderson, IN 46016

Meridian Health Rx -- Richmond
520 S 9th St
Suite A
Richmond, IN 47374

Meridian Health Rx
205 N Tillotson Ave
Suite 100
Muncie, IN 47304
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC26567-00ActiveBPS-H80-013325MERIDIAN SERVICES CORPMeridian Health Services240 N Tillotson Ave MuncieIN
CHC26567-01ActiveBPS-H80-013597MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp110 North Tillotson Ave MuncieIN
CHC26567-02ActiveBPS-H80-013596MERIDIAN SERVICES CORPSuzanne Gresham Center Division of Meridian Services3620 White River Blvd MuncieIN
CHC26567-03ActiveBPS-H80-013360MERIDIAN SERVICES CORPMeridian Health Services509 Conrad Harcourt Way RushvilleIN
CHC26567-04TerminatedBPS-H80-013785MERIDIAN SERVICES CORPMeridian Muncie Women's Health Center2501 W JACKSON ST MUNCIEIN
CHC26567-05ActiveBPS-H80-017040MERIDIAN SERVICES CORPMeridian Health Services - Richmond2300 Chester Blvd RichmondIN
CHC26567-06ActiveBPS-H80-015729MERIDIAN SERVICES CORPMeridian Health Services - Henry County930 N 14TH ST NEW CASTLEIN
CHC26567-07ActiveBPS-H80-015710MERIDIAN SERVICES CORPMeridian Health Services - West Jay1150 S MAIN ST DUNKIRKIN
CHC26567-08ActiveBPS-H80-015310MERIDIAN SERVICES CORPMeridianMD100 North Tillotson Avenue MuncieIN
CHC26567-09TerminatedBPS-H80-014235MERIDIAN SERVICES CORPMeridian Health Services Richmond16 SW 5TH ST RICHMONDIN
CHC26567-10ActiveBPS-H80-014849MERIDIAN SERVICES CORPMeridian Health Services Pediatrics205 N TILLOTSON AVE MUNCIEIN
CHC26567-11ActiveBPS-H80-019074MERIDIAN SERVICES CORPMERIDIAN HEALTH SERVICES CORP.130 N Tillotson Ave MuncieIN
CHC26567-12ActiveBPS-H80-018872MERIDIAN SERVICES CORPMeridianMD Convenience Care500 W Votaw St PortlandIN
CHC26567-13ActiveBPS-H80-018018MERIDIAN SERVICES CORPMeridian Health Services Corp. Walnut Commons110 E Wysor St MuncieIN
CHC26567-14TerminatedBPS-H80-021350MERIDIAN SERVICES CORPMeridian Health Services - Chase Bldg., Suite 200630 E Main Street RichmondIN
CHC26567-15TerminatedBPS-H80-021707MERIDIAN SERVICES CORPMeridian Health Services - Suite 102A2506 Willowbrook Pkwy IndianapolisIN
CHC26567-16ActiveBPS-H80-024663MERIDIAN SERVICES CORPMeridian Health Services Corp707 W. 3rd St. ConnersvilleIN
CHC26567-17TerminatedBPS-H80-027144MERIDIAN SERVICES CORPMeridian Health Services Corp498 NW 18th St BLDG 416 Ste D RichmondIN
CHC26567-18ActiveBPS-H80-027573MERIDIAN SERVICES CORPMeridian Health Services Corp1547 Ohio Ave AndersonIN
CHC26567-19ActiveBPS-H80-027572MERIDIAN SERVICES CORPMeridian Health Services Corp101 N Harrison St AlexandriaIN
CHC26567-20ActiveBPS-H80-027574MERIDIAN SERVICES CORPMeridian Health Services Corp1518 Main St ElwoodIN
CHC26567-21ActiveBPS-H80-030283Meridian Health Services Corp.Meridian Health Services Corp.520 S 9th St Ste A RichmondIN
CHC26567-22ActiveBPS-H80-030284Meridian Health Services Corp.Meridian Health Services Corp303 S Main St Ste 300 BlufftonIN
CHC26567-23ActiveBPS-H80-030477Meridian Health Services Corp.Meridian Health Services Corp.1601 E 26th St # 6 MuncieIN
CHC26567-24ActiveBPS-H80-031021Meridian Health Services Corp.Meridian Health Services Corp801 N Walnut St # 1 MuncieIN
CHC26567-25TerminatedBPS-H80-031622Meridian Health Services Corp.Meridian Health Services Corp.498 NW 18th St BLDG 417 STE D RichmondIN
CHC26567-26ActiveBPS-H80-032015Meridian Health Services Corp.Meridian Health Services Corp4755 Kingsway Dr Ste 105A IndianapolisIN
CHC26567-27ActiveBPS-H80-032545Meridian Health Services Corp.Meridian Health Services Corp.2010 Brentwood Dr Ste 1 AndersonIN
CHC26567-28ActiveBPS-H80-032443Meridian Health Services Corp.Meridian Health Services Corp931 W Water St Ste A PortlandIN
CHC26567-29ActiveBPS-H80-035098Meridian Health Services Corp.Meridian Health Services Corp2622 Lake Ave STE 1 Fort WayneIN
CHC26567-30ActiveBPS-H80-036195Meridian Health Services Corp.Meridian Health Services Corp911 N Western Ave MarionIN
CHC26567-31ActiveBPS-H80-036196Meridian Health Services Corp.Meridian Health Services Corp406 W Votaw St PortlandIN
CHC26567-32ActiveBPS-H80-035549Meridian Health Services Corp.Meridian Health Services Corp1026 S Main St STE 1 BlufftonIN
CHC26567-33ActiveBPS-H80-037027MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp1001 Hadley Rd, Ste 103 MooresvilleIN
CHC26567-34ActiveBPS-H80-036944MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp5230 E Stop 11 Road STE 300 IndianapolisIN
CHC26567-35ActiveBPS-H80-035885MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp8707 W US Highway 36 RM N2 ModocIN
CHC26567-36ActiveBPS-H80-036773MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp424 E Southway Blvd Ste 1 KokomoIN
CHC26567-37ActiveBPS-H80-033520MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp730 W Washington St STE A WinchesterIN
CHC26567-38ActiveBPS-H80-037821MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp2072 IN-67 PortlandIN
CHC26567-39ActiveBPS-H80-035769MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp380 Hub Etchison Parkway RM R144 RichmondIN
CHC26567-40ActiveBPS-H80-035787MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp501 1/2 S 7th St RM 1 RichmondIN
CHC26567-41ActiveBPS-H80-037324MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp101 W 29th St AndersonIN
CHC26567-42ActiveBPS-H80-038092MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp323 E 2nd St STE 1 MarionIN
CHC26567-43ActiveBPS-H80-037325MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp1 South Maish Road RM A016 FrankfortIN
CHC26567-44ActiveBPS-H80-037822MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp50 S Maish Rd FrankfortIN
CHC26567-45ActiveBPS-H80-039129MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp285 W 12th St STE 102 PeruIN
CHC26567-46ActiveBPS-H80-039128MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp285 W 12th St STE 206 PeruIN
CHC26567-47ActiveBPS-H80-039130MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp285 W 12th St STE 205 PeruIN
CHC26567-48ActiveBPS-H80-038918MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp1500 Salem St STE 110A LafayetteIN
CHC26567-49ActiveBPS-H80-038916MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp2600 County Road 600 W RM SG-1 RussiavilleIN
CHC26567-50ActiveBPS-H80-039076MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp105 Hillcrest Dr OssianIN
CHC26567-51ActiveBPS-H80-039079MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp125 E Cherry St BlufftonIN
CHC26567-52ActiveBPS-H80-038917MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp731 N Plum St RM 107 Union CityIN
CHC26567-53ActiveBPS-H80-039077MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp201 E South St MarkleIN
CHC26567-54ActiveBPS-H80-039358MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp303 S. Main Street STE #500 BlufftonIN
CHC26567-55ActiveBPS-H80-039078MERIDIAN HEALTH SERVICES CORP.Meridian Health Services Corp824 Huntington Ave WarrenIN
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC26567-00AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271201/01/2020  
CHC26567-00AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291101/01/2020  
CHC26567-00AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700304/01/2025  
CHC26567-00AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503401/01/2020  
CHC26567-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2024  
CHC26567-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2024  
CHC26567-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2024  
CHC26567-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/01/2022  
CHC26567-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/01/2022  
CHC26567-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/01/2022  
CHC26567-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/01/2022  
CHC26567-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/01/2022  
CHC26567-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/01/2022  
CHC26567-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/01/2022  
CHC26567-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/01/2022  
CHC26567-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/01/2022  
CHC26567-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2022  
CHC26567-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870610/01/2022  
CHC26567-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005610/01/2022  
CHC26567-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2022  
CHC26567-00DOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K
GREENVILLESC29607-654104/01/2024  
CHC26567-00GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-03GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-02GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-01GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016 10/01/2019
CHC26567-04GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016 04/01/2017
CHC26567-10GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-09GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016 04/01/2018
CHC26567-08GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-07GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-06GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-05GENOA HEALTHCARE LLC130 N. TILLOTSON AVENUE
MUNCIEIN47304-398707/01/2016  
CHC26567-00GENOA HEALTHCARE LLC831 DILLON DR STE 102
RICHMONDIN4737401/01/2022  
CHC26567-00HEALTHY OPTIONS INCDBA POSTAL PRESCRIPTION SVCS 3500 SE 26TH AVE
PO BOX 2718
PORTLANDOR9720201/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06616 425 E MEMORIAL DR
MUNCIEIN4730204/01/2017  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06623 201 S. TILLOTSON AVENUE
MUNCIEIN4730404/01/2017  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06645 101 WEST 1ST ST.
RUSHVILLEIN4617304/01/2017  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06652 301 N. GRAND AVE
CONNERSVILLEIN4733110/01/2019  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06632 1130 S MAIN ST
DUNKIRKIN4733610/01/2019  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06640 265 SO. SCATTERFIELD RD
ANDERSONIN4601210/01/2019  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06624 802 N MERIDIAN ST
PORTLANDIN4737110/01/2019  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06631 3310 E. JACKSON ST.
MUNCIEIN4730301/01/2022 01/11/2023
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 03162 2150 CHESTER BLVD.
RICHMONDIN4737401/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06647 1515 EAST MAIN STREET
RICHMONDIN4737401/01/2022 03/03/2025
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06515 1203 S. MAIN ST.
BLUFFTONIN4671401/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06636 298 SOUTH WEST 18TH ST.,
RICHMONDIN4737401/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06656 3824 MAIN STREET
ANDERSONIN4601310/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06517 1901 N. JEFFERSON ST.
HUNTINGTONIN4675010/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06516 1221 WEST MONROE ST.
DECATURIN4673310/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06643 220 S. MEMORIAL DR.
NEW CASTLEIN4736210/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06528 928 US 27 N
BERNEIN4671110/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY #06622 1700 N. WALNUT ST
HARTFORD CITYIN4734810/01/2022  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 08657 1725 SALEM STREET
LAFAYETTEIN4790401/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06509 2802 EAST STATE BOULEVARD
FORT WAYNEIN4680501/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.CVS PHARMACY # 16860 3601 N BARR ST
MUNCIEIN4730301/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06617 100 N ANDERSON ST.
ELWOODIN4603601/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06620 943 EAST WASHINGTON STREET
WINCHESTERIN4739401/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06618 105 NORTH PARK AVE
ALEXANDRIAIN4600101/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.CVS PHARMACY # 17294 3801 COLDWATER RD
FORT WAYNEIN4680501/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06662 711 W. MILL ST.
MIDDLETOWNIN4735601/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06519 5802 SOUTH ANTHONY BLVD.
FORT WAYNEIN4681604/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 02484 4630 SO. WASHINGTON ST.
MARIONIN4695307/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06621 415 W. 3RD ST.
MARIONIN4695207/01/2023  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06703 789 STATE ROAD 39 BY-PASS
MARTINSVILLEIN4615101/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 04468 7935 S EMERSON AVENUE
SUITE B
INDIANAPOLISIN4623701/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06610 8405 SOUTHEASTERN AVE.
INDIANAPOLISIN4623901/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06551 523 SOUTH STATE ROAD 67
MOORESVILLEIN4615804/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06648 655 S. US HIGHWAY 31
GREENWOODIN4614204/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 08690 5920 MADISON AVENUE
INDIANAPOLISIN4622704/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06520 3918 SOUTH CALHOUN ST.
FORT WAYNEIN4680704/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 03297 4935 S. ARLINGTON
INDIANAPOLISIN4623704/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06644 640 SOUTH STATE ROAD 135
GREENWOODIN4614210/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06654 8970 S. MERIDIAN ST.
INDIANAPOLISIN4621710/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06637 200 S. HARRISON
SHELBYVILLEIN4617610/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06661 263 W MORGAN ST.
KNIGHTSTOWNIN4614810/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 00684 7930 MADISON AVE.
INDIANAPOLISIN4622710/01/2024  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 08651 512 SAGAMORE PKWY WEST
WEST LAFAYETTEIN4790604/01/2025  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 06545 2 SOUTH BROADWAY
PERUIN4697004/01/2025  
CHC26567-00HOOK-SUPERX, L.L.C.DBA: CVS/PHARMACY # 02311 2215 SOUTH SHELBY STREET
INDIANAPOLISIN4620307/01/2025  
CHC26567-00HOOK-SUPERX, L.L.C.DBA CVS/PHARMACY # 3007 6010 SOUTH EMERSON AVENUE
INDIANAPOLISIN4623707/01/2025  
CHC26567-00KROGER COLUMBUS CENTRAL FILL #0192270 RICKENBACKER PKWY W
COLUMBUSOH4321704/01/2021  
CHC26567-00KROGER LIMITED PARTNERSHIP IDBA PAYLESS PHARMACY J827 2513 MAPLE POINT DRIVE
LAFAYETTEIN4790501/01/2023 08/06/2024
CHC26567-00KROGER PHARMACY202 S MAIN STREET
RUSHVILLEIN4617304/01/2021  
CHC26567-00M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312601/01/2020  
CHC26567-00MEIJER DISTRIBUTION INC #902721 WALKER AVE NW
GRAND RAPIDSMI4954404/01/2021  
CHC26567-00MEIJER PHARMACY #1396260 W. MCGALLIARD RD (SR 332)
MUNCIEIN47304-941304/01/2021  
CHC26567-00MEIJER PHARMACY #1552507 CHESTER BLVD
RICHMONDIN4737404/01/2021  
CHC26567-00MEIJER PHARMACY #46441255 COCA COLA DR.
BELLEVILLEMI48111-182704/01/2021  
CHC26567-00MEIJER STORES LIMITED PARTNERSHIPD/B/A MEIJER PHARMACY #463 1515 PROFIT DR.
FORT WAYNEIN4680804/01/2021  
CHC26567-00OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/01/2021  
CHC26567-00OPTUMRX2858 LOKER AVE E STE 100
CARLSBADCA92010-660807/01/2021 09/10/2024
CHC26567-00PAYLESS PHARMACY 848KROGER LIMITED PARTNERSHIP I 3050 MERIDIAN ST
ANDERSONIN4601601/01/2023 08/06/2024
CHC26567-00PHILLIPS DRUG631 E MAIN ST
RICHMONDIN47374-430904/01/2020  
CHC26567-00PHILLIPS DRUGS EAST1626 E MAIN ST
RICHMONDIN4737404/01/2020  
CHC26567-00PHILLIPS DRUGS INC1390 NATIONAL RD WEST
RICHMONDIN4737404/01/2020  
CHC26567-00PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310101/01/2020  
CHC26567-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/01/2022  
CHC26567-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681310/01/2022 01/11/2023
CHC26567-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/01/2022 01/11/2023
CHC26567-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2022 01/11/2023
CHC26567-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523310/01/2023  
CHC26567-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2023  
CHC26567-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681310/01/2023  
CHC26567-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2024  
CHC26567-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2024  
CHC26567-00SANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/01/2024  
CHC26567-00STERLING SPECIALTY PHARMACY1312 NORTHLAND DRIVE SUITE 500
MENDOTA HEIGHTSMN55120-114004/01/2020  
CHC26567-00THE KROGER CO#920 120 S MEMORIAL DR
NEW CASTLEIN4736201/01/2023 08/06/2024
CHC26567-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/01/2021  
CHC26567-00WAL-MART PHARMACY #10-17282321 CHARLES STREET
ANDERSONIN4601304/01/2021  
CHC26567-00WAL-MART PHARMACY 10-1480950 EAST GREENVILLE PIKE
WINCHESTERIN4739410/01/2024  
CHC26567-00WAL-MART PHARMACY 10-16654801 W. CLARA LN
MUNCIEIN4730401/01/2022  
CHC26567-00WAL-MART PHARMACY 10-17294200 WESTERN AVENUE
CONNERSVILLEIN4733110/01/2024  
CHC26567-00WAL-MART PHARMACY 10-17453601 E. MAIN
RICHMONDIN4737404/01/2021  
CHC26567-00WAL-MART PHARMACY 10-17583167 S STATE RD #3
NEW CASTLEIN4736210/01/2024  
CHC26567-00WAL-MART PHARMACY 10-2388950 W VOTAW
PORTLANDIN4737104/01/2017  
CHC26567-00WAL-MART PHARMACY 10-28192100 NO. MAIN STREET
BLUFFTONIN4671404/01/2021  
CHC26567-00WAL-MART PHARMACY 10-37471501 EAST 29TH STREET
MUNCIEIN4730201/01/2022  
CHC26567-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/01/2021  
CHC26567-00WALGREEN CODBA: WALGREENS #12676 124 W VOTAW STREET
PORTLANDIN4737104/01/2017 11/16/2022
CHC26567-00WALGREEN CODBA: WALGREENS #10533 3250 N MORRISON ROAD
MUNCIEIN4730404/01/2017  
CHC26567-00WALGREEN CODBA: WALGREENS SPECIALTY PHARMACY #12470 330 N WABASH AVENUE STE 100
MARIONIN4695207/01/2023  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 05803 2720 W JACKSON
MUNCIEIN4730304/01/2017  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 06420 400 E MEMORIAL DRIVE
MUNCIEIN4730204/01/2017  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 05802 100 E MCGALLIARD RD
MUNCIEIN4730304/01/2017  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 09128 3700 NATIONAL RD E
RICHMONDIN4737404/01/2017  
CHC26567-00WALGREEN CO.W002 DBA: WALGREENS #07690 100 N. MEMORIAL DR
NEW CASTLEIN4736204/01/2017  
CHC26567-00WALGREEN CO.DBA: WALGREENS SPECIALTY PHARMACY #16317 335 MASSACHUSETTS AVENUE
INDIANAPOLISIN4620404/01/2017  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 07472 1975 N MAIN ST
BLUFFTONIN46714-118201/01/2022  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 07788 320 S SCATTERFIELD RD
ANDERSONIN46012-360101/01/2022  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 06761 3736 S SCATTERFIELD RD
ANDERSONIN4601301/01/2022  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 05663 1323 N BALDWIN AVE
MARIONIN4695201/01/2023  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 05452 2410 N COLISEUM BLVD
FT WAYNEIN4680501/01/2023 03/25/2025
CHC26567-00WALGREEN CO.DBA: WALGREENS # 02932 1701 EAST PAULDING ROAD
FORT WAYNEIN4681604/01/2024 02/20/2024
CHC26567-00WALGREEN CO.WALGREENS #11846 1213 N. BARRON ST
EATONOH45320-101304/01/2024  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 04190 6730 BLUFFTON RD.
FT WAYNEIN4680904/01/2024  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 03722 110 E. CREIGHTON AVE.
FT WAYNEIN4680307/01/2024  
CHC26567-00WALGREEN CO.DBA WALGREENS #16558 1400 N RITTER AVE.
SUITE 140
INDIANAPOLISIN4621910/01/2024  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 06066 1804 N JEFFERSON
HUNTINGTONIN4675004/01/2025  
CHC26567-00WALGREEN CO.DBA: WALGREENS # 09827 720 N BROADWAY
PERUIN46970-102704/01/2025  
CHC26567-00Walgreens Central Fill #213994132Plainfield Rd
Ste 110
IndianapolisIN46231-702104/01/2023  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressDeleteRecertificationMeridian Health Rx 205 N Tillotson Ave Suite A Muncie, IN 47304 2/18/2025 9:13 AM
DetailsLast Recertification DateUpdateRecertification1/31/2024 6:12:00 AM2/18/2025 9:13:51 AM2/18/2025 9:13 AM
AddressesShipping AddressInsertGroup Change Request Meridian Health Rx 205 N Tillotson Ave Suite 100 Muncie, IN 473048/13/2024 5:25 PM
Medicaid BillingMedicaid: NumberDeleteChange Request201061740 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300061835 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100258720 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300049399 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300075833 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300077506 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request201069460 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberDeleteChange Request300015569 (IN) 6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000845436/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000314066/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000791626/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000792606/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010986306/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010034006/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000134886/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000220486/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000826746/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1002323306/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000858106/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/13/2024 1:30 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000813076/13/2024 1:30 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1386844579 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1790398824 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1629013677 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1295327641 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1467155879 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1477210367 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1154681096 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberDeleteChange Request1285125765 (IN) 6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 18814684526/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 11947001796/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 19527182316/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 15982450376/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 17206924946/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 13960754876/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 13564862866/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 16294851076/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 14477313026/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 13369273006/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 18614297146/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 16397557396/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 17006507856/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingNPI: NumberInsertChange Request 17005694236/13/2024 1:30 PM
Medicaid BillingNPI: StateInsertChange Request IN6/13/2024 1:30 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1003486803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2013564903/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000678293/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000205923/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2008726303/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000352013/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000348133/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000825093/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000797453/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000264933/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000734963/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000406153/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2002957403/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000026743/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000355723/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012360003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000295693/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010736003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2008668203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000534013/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2002635203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012287803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000291483/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2004236803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000543273/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000796653/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000613993/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000515293/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2003764903/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010617403/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000832903/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000574923/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2003758103/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000868843/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2003195803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012270303/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000618353/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000396043/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000643233/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012284003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010005503/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2013545003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000269363/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000377733/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2002816303/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012933703/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1000980703/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2013185703/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1002587203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000493993/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000650963/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2001760103/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000217323/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2009800903/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000758333/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000301393/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000726073/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000329023/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2001264803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000368093/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2001989203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000828003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000775063/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010335503/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1003301803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000802093/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010288003/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000809073/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2009586403/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000816703/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1003660803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010406103/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010941203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000860143/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010694603/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000813233/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000084513/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2005240103/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000274743/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 1001150203/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000820603/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000188803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2000284363/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2001084803/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2009611603/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000155693/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000840053/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000684153/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000683413/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000437153/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2010028303/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/13/2024 2:50 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000828573/13/2024 2:50 PM
Medicaid BillingMedicaid: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16199354753/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18415452823/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11843558693/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15881477553/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16998223203/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13961965563/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17307221253/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15288464743/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12550107323/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12758744893/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15883614633/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14478884743/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12856863293/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14972933773/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18516535883/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17305096053/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11942785073/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14272123983/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13169823093/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11649559363/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16593614833/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10637396703/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19821677063/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13563254843/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10236343183/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16994526493/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14872060413/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15781076373/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14876002353/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13868445793/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16893626913/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11448197643/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12059838553/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12250103583/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11947846033/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18718737113/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17903988243/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11548428133/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19326060013/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19627828053/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16292861413/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11042395163/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14779942913/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10832410123/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18311396663/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14071460043/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16694679323/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17709693393/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16290136773/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12953276413/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16691173703/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15785075393/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16093954253/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19322200353/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14671558793/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19221084143/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16590867343/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10334056263/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15987211283/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11041887543/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10836554273/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 15489453893/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14772103673/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13362768233/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18715697723/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10338916013/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13161013633/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17005639133/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13767177443/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13662209073/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11048032123/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17102623083/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16495293483/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17006589523/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11546810963/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14975342003/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11043454203/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19523133143/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 14376122723/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11442160603/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16399576813/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11346015523/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 16092590013/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 18018789473/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 19525665723/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 12851257653/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 10036961393/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 17205486213/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 11540468113/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13468478863/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13465417863/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
Medicaid BillingNPI: NumberInsertChange Request 13863255873/13/2024 2:50 PM
Medicaid BillingNPI: StateInsertChange Request IN3/13/2024 2:50 PM
DetailsLast Recertification DateUpdateRecertification 1/31/2024 6:12:00 AM1/31/2024 6:12 AM
Medicaid BillingMedicaid: NumberDeleteChange Request201296390 (IN) 12/19/2023 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/19/2023 8:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 30006712012/19/2023 8:52 AM
Medicaid BillingMedicaid: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/19/2023 8:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 30007793012/19/2023 8:52 AM
Medicaid BillingMedicaid: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/19/2023 8:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 30008108012/19/2023 8:52 AM
Medicaid BillingMedicaid: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/19/2023 8:52 AM
Medicaid BillingMedicaid: NumberInsertChange Request 20138597012/19/2023 8:52 AM
Medicaid BillingMedicaid: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingNPI: NumberDeleteChange Request1376835926 (IN) 12/19/2023 8:52 AM
Medicaid BillingNPI: NumberInsertChange Request 152870678512/19/2023 8:52 AM
Medicaid BillingNPI: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingNPI: NumberInsertChange Request 131665824812/19/2023 8:52 AM
Medicaid BillingNPI: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingNPI: NumberInsertChange Request 176019369212/19/2023 8:52 AM
Medicaid BillingNPI: StateInsertChange Request IN12/19/2023 8:52 AM
Medicaid BillingNPI: NumberInsertChange Request 199274833912/19/2023 8:52 AM
Medicaid BillingNPI: StateInsertChange Request IN12/19/2023 8:52 AM
DetailsStateUpdate ApprovedActive7/1/2023 12:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/19/2023 12:32 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2012963906/19/2023 12:32 PM
Medicaid BillingMedicaid: StateInsertChange Request IN6/19/2023 12:32 PM
Medicaid BillingNPI: NumberInsertChange Request 13768359266/19/2023 12:32 PM
Medicaid BillingNPI: StateInsertChange Request IN6/19/2023 12:32 PM
ContactsSigned ByInsertNew Registration Riggs, Scott Chief Financial Officer Meridian Health Services 76525451895/4/2023 8:21 AM
Details340B IDUpdateNew Registration CHC26567-325/4/2023 8:21 AM
DatesParticipating Approval DateUpdateNew Registration 5/4/2023 8:21:13 AM5/4/2023 8:21 AM
DetailsStateUpdateNew RegistrationPendingApproved5/4/2023 8:21 AM
DatesSigned By DateUpdateNew Registration 5/2/2023 2:25:47 PM5/4/2023 8:21 AM
DatesStart DateUpdateNew Registration 7/1/2023 12:00:00 AM5/4/2023 8:21 AM
AddressesMain AddressInsertNew Registration  1026 S Main St STE 1 Bluffton, IN 46714-36145/2/2023 12:50 PM
AddressesBilling AddressInsertNew Registration Meridian Health Services Corp. 240 N Tillotson Ave Muncie, IN 473045/2/2023 12:50 PM
AddressesShipping AddressInsertNew Registration Meridian Health Services 1026 S Main St STE 1 Bluffton, IN 467145/2/2023 12:50 PM
AddressesShipping AddressInsertNew Registration Meridian Health Rx 205 N Tillotson Ave Suite A Muncie, IN 473045/2/2023 12:50 PM
AddressesShipping AddressInsertNew Registration Meridian Health Rx -- Anderson 1547 Ohio Ave Suite A Anderson, IN 460165/2/2023 12:50 PM
AddressesShipping AddressInsertNew Registration Meridian Health Rx -- Richmond 520 S 9th St Suite A Richmond, IN 473745/2/2023 12:50 PM
ContactsAuthorizing OfficialInsertNew Registration Riggs, Scott Chief Financial Officer Meridian Health Services 76525451895/2/2023 12:50 PM
ContactsPrimary ContactInsertNew Registration Thomas, Amy 340B Program Coordinator Meridian Health Services - 76531365335/2/2023 12:50 PM
DetailsAssistance Received From DateInsertNew Registration  5/2/2023 12:50 PM
DetailsAssistance Received To DateInsertNew Registration  5/2/2023 12:50 PM
DetailsLast Recertification DateInsertNew Registration  5/2/2023 12:50 PM
DetailsGrant NumberInsertNew Registration H80CS265675/2/2023 12:50 PM
Details340B IDInsertNew Registration  5/2/2023 12:50 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  5/2/2023 12:50 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  5/2/2023 12:50 PM
DetailsMedicare Provider NumberInsertNew Registration  5/2/2023 12:50 PM
DetailsEntity NameInsertNew Registration Meridian Health Services Corp.5/2/2023 12:50 PM
DetailsNOFO NumberInsertNew Registration  5/2/2023 12:50 PM
DetailsProgram CodeInsertNew Registration CH5/2/2023 12:50 PM
DetailsEntity SubnameInsertNew Registration Meridian Health Services Corp5/2/2023 12:50 PM
DatesParticipating Approval DateInsertNew Registration  5/2/2023 12:50 PM
DetailsStateInsertNew Registration Pending5/2/2023 12:50 PM
DatesRegistration DateInsertNew Registration 5/2/2023 12:50:48 PM5/2/2023 12:50 PM
DatesSigned By DateInsertNew Registration  5/2/2023 12:50 PM
DatesStart DateInsertNew Registration  5/2/2023 12:50 PM
TerminationsTermination CommentsInsertNew Registration  5/2/2023 12:50 PM
TerminationsTermination DateInsertNew Registration  5/2/2023 12:50 PM
TerminationsTermination Effective DateInsertNew Registration  5/2/2023 12:50 PM
TerminationsTermination ReasonInsertNew Registration  5/2/2023 12:50 PM