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DSH150051F IU HEALTH BLOOMINGTON HOSPITAL (Terminated)
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Main Details
Name
IU HEALTH BLOOMINGTON HOSPITAL
Subdivision Name
IU HEALTH REHABILITATION AND SPORTS
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150051F
Medicare Provider Number
150051
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
Indiana University Health
Jennifer M. Alvey, SVP & CFO
(317) 963-0213
Primary Contact
IU Health, Inc.
Jennifer Ann Hatchett, Senior Financial Analyst
(317) 962-4243
Addresses
Street Address
2499 W COTA DR
BLOOMINGTON, IN 47403-4217
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Previously participated as RRC150051-10 starting in 1/1/2014. Converted to a DSH 10/1/2016.
07/07/2016
June 2025
June 2025
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