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DSH150074BM COMMUNITY HOSPITAL OF INDIANA INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITAL OF INDIANA INC.
Subdivision Name
Wound Center - CHWV
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150074BM
Medicare Provider Number
150074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/24/2016
Last Recertification Date
Termination Date
Termination Reason
10/1/2016
DSH percentage below statutory minimum
Contacts
Authorizing Official
Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337
Primary Contact
Ken Menser, Pharmacy Director
(317) 920-7362
Addresses
Street Address
3520 Guion Road # 100
Indianapolis, IN 46222
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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