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DSH150056FJ INDIANA UNIVERSITY HEALTH INC (Terminated)
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Main Details
Name
INDIANA UNIVERSITY HEALTH INC
Subdivision Name
IU Health Ophthamology Pediatric Service
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150056FJ
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
9/11/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
Indiana University Health
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Primary Contact
IU Health
Caroline Drum Bradley, Program Director
(317) 963-1628
Addresses
Street Address
705 Riley Hospital Dr
Indianapolis, IN 46202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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