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SCH150072-00 MEMORIAL HOSPITAL LOGANSPORT (Terminated)
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Main Details
Name
MEMORIAL HOSPITAL LOGANSPORT
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH150072-00
Medicare Provider Number
150072
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/28/2016
Last Recertification Date
9/19/2022
Termination Date
Termination Reason
4/1/2023
Change of covered entity type
Contacts
Authorizing Official
Memorial Hospital Logansport
Perry Gay, CEO
(574) 753-1385
Primary Contact
Memorial Hospital Logansport
Beth Jump, COO
(574) 753-1409
Addresses
Street Address
1101 MICHIGAN AVENUE
LOGANSPORT, IN 46947
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated as DSH150072 from 7/1/2009-7/1/2016. Converted to SCH effective 7/1/2016.
04/27/2016
April 2025
April 2025
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