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DSH150074AZ COMMUNITY HOSPITALS OF INDIANA, INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITALS OF INDIANA, INC.
Subdivision Name
Pulmonary Rehab-CHVH
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150074AZ
Medicare Provider Number
150074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/20/2015
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
4/1/2020
Site closure
Contacts
Authorizing Official
Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337
Primary Contact
Community Health Network
Ashley Marie Harlow, Director, 340B and Strategic Pharmacy Revenue
(317) 621-1791
Addresses
Street Address
8075 N. Shadeland Ave
STE 130
Indianapolis, IN 46250
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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