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DSH150074T COMMUNITY HOSPITALS OF INDIANA, INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITALS OF INDIANA, INC.
Subdivision Name
Family Practice Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150074T
Medicare Provider Number
150074
Outpatient Facility Provider Number
150074
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
Termination Date
Termination Reason
7/1/2015
Loss of qualifying grant/support
Contacts
Authorizing Official
Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337
Primary Contact
David Cruse, Pharmacy Director
(317) 355-5106
Addresses
Street Address
10122 E 10th ST STE 100
Indianapolis, IN 46229
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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