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Background. More effective treatment for hepatitis C virus (HCV) creates an opportunity to improve health outcomes. Objective. To use Centers for Medicare and Medicaid Services (CMS)-defined HCV quality indicators (QI) as a framework to assess the quality of care at an urban safety net hospital. Design. Retrospective cohort. Participants. Patients engaged in care (at least two outpatient visits, and minimum six-month follow-up time) between 2005 and 2011. Outcomes measures. 1) HCV ribonucleic acid (RNA); 2) genotyping; 3) treatment; and 4) Hepatitis A and B vaccination. Study time was divided into three periods: 1) 2005–2006, 2) 2007–2008, 3) 2009–2011. Key results. Number who met inclusion criteria: 3,018; 13% were human immunodeficiency virus co-infected. Only 1% completed the care recommended in the CMS quality indicators that were evaluated. Later time periods were independently associated with greater rates (aHR for HCV testing, 1.15; 95% CI, 1.04–1.28). Conclusions. Quality of care is improving, but it remains suboptimal. Initiatives are needed to increase QI completion.