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DSH150056Y INDIANA UNIVERSITY HEALTH INC (Terminated)
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Main Details
Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
Indiana University Health Adult Dialysis Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150056Y
Medicare Provider Number
150056
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/13/2012
Last Recertification Date
9/7/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Indiana University Health
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Primary Contact
Dawn Moore, VP, Pharmacy Administration
(317) 948-0319
Addresses
Street Address
2140 N. Capitol Street
Indianapolis, IN 46202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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