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DSH150072 MEMORIAL HOSPITAL LOGANSPORT (Active)
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Main Details
Name
MEMORIAL HOSPITAL LOGANSPORT
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH150072
Medicare Provider Number
150072
Additional Details
Current Program Status
Active
Registration Date
1/9/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/17/2023
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
Memorial Hospital
Tara McVay, CNO
(574) 753-1568
Primary Contact
DSH150072
Lindsey Hayden, 340B Program Director
(574) 753-1401
Addresses
Street Address
1101 MICHIGAN AVENUE
LOGANSPORT, IN 46947
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2009; Terminated 7/1/2016; Reinstated 4/1/2023.
01/17/2023
Participated starting 7/1/2019; Terminated 7/1/2016; Reinstated 4/1/2023.
01/17/2023
11/23/09 DOC RECD TO CONFIRM ELIG DSH ADJ %; 7/28/09 OPA NOTIFIED HOSPITAL CARVING OUT MEDICAID EFFECTIVE 7/1/09 (WAS 100269180A)
12/14/2009
April 2025
April 2025
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