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DSH150056ER INDIANA UNIVERSITY HEALTH INC (Terminated)
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Main Details
Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
IU Health Genet Lab Medical Genetics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150056ER
Medicare Provider Number
150056
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/7/2012
Last Recertification Date
11/28/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Indiana University Health
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Primary Contact
Indiana University Health, Inc.
Don Davies, Manager of 340B/Audit
(317) 963-2580
Addresses
Street Address
350 W 11th St
Indianapolis, IN 46202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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