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DSH150097 MAJOR HOSPITAL (Active)
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Main Details
Name
MAJOR HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH150097
Medicare Provider Number
150097
Additional Details
Current Program Status
Active
Registration Date
4/15/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/18/2022
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Major Hospital
Ralph N Mercuri, CFO
(317) 398-5254
Primary Contact
Major Hospital
Kelly Connolly, Director of Pharmacy
(317) 398-5306
Addresses
Street Address
2451 INTELLIPLEX DR
SHELBYVILLE, IN 46176
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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