340B Drug Pricing Program Database
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DSH150169L COMMUNITY HOSPITAL OF INDIANA INC. (Terminated)
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Main Details
Name
COMMUNITY HOSPITAL OF INDIANA INC.
Subdivision Name
REHAB & SPORTS MEDICINE NOBLESVILLE - Rehab & Sports Medicine - Noblesville
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150169L
Medicare Provider Number
150169
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/3/2018
Last Recertification Date
Termination Date
Termination Reason
1/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Community Hospital Indianapolis Region
David Kiley, President
(317) 621-9337
Primary Contact
Community Health Network North Hospital
Derek McMichael, Director of Pharmacy, North Hospital
(317) 621-5388
Addresses
Street Address
9669 E 146TH ST
NOBLESVILLE, IN 46060-5005
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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