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CH051741H SHALOM HEALTH CARE CENTER, INC. (Active)
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Main Details
Name
SHALOM HEALTH CARE CENTER, INC.
Subdivision Name
SHALOM PRIMARY CARE CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-003104
340B ID
CH051741H
Grant Number
H80CS00880
Additional Details
Current Program Status
Active
Registration Date
4/16/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/20/2018
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Shalom Health Care Center
Leonardo R. Ortega, Executive Director/CEO
(317) 291-7422 Ext: 1105
Primary Contact
Shalom Health Center
Bianca Daisy-Bell, Clinical Pharmacist
(317) 291-7422 Ext: 1422
Addresses
Street Address
3400 Lafayette Rd
Indianapolis, IN 46222-1146
Billing Address
SHALOM HEALTH CARE CENTER, INC.
3400 Lafayette Rd
200
Indianapolis, IN 46222-1146
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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Participating from effective date (04/01/2006) until terminated effective date (04/01/2018), reinstatement date effective date (07/01/2018)
04/19/2018
April 2025
April 2025
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