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DSH150113A COMMUNITY HOSPITAL ANDERSON (Terminated)
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Main Details
Name
COMMUNITY HOSPITAL ANDERSON
Subdivision Name
COMMUNITY HOSPITAL ANDERSON OUTPATI - Outpatient Imaging Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150113A
Medicare Provider Number
150113
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/18/2018
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Community Health Network
Beth Tharp, SVP/President of Hospital Services
(765) 298-5125
Primary Contact
Community Hospital of Anderson
Homand Bahrami, Pharmacy Director
(765) 298-2427
Addresses
Street Address
1130 MEDICAL ARTS BLVD
ANDERSON, IN 46011-3432
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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