Covered Entity Details

DSH160058CZ UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER (Approved) - information as of 6/4/2025 11:59:27 AM

Main Details

Name

UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER

Subdivision Name

UNIVERSITY OF IOWA HEALTH CARE - IRL Diabetes Center Clinical Nutrition

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH160058CZ

Medicare Provider Number

160058

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/15/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/8/2025

Last Recertification Date

Contacts

Authorizing Official

University of Iowa Health Care
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371

Primary Contact

University of Iowa Health Care
Becky Marie Triplett, Manager, 340B and Compliance
(319) 384-5583

Addresses

Street Address

105 East 9th Street
Coralville, IA 52241

Billing Address

University of Iowa Accounts Payable
202 PCO
Iowa City, IA 52242

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IA	0260927,0501847,0600585,0713967	1093790578,1114732559,1114905387,1174845101,1194035436,1265433676,1265523062,1275048217,1275534620,1285635235,1306304027,1326589482,1346386513,1376544320,1386809457,1437295607,1477554814,1508858127,1548248321,1578639126,1629054846,1629219498,1639157415,1730180761,1811246473,1811984636,1841346970,1881679371,1932904927,1972588465,1982799045
IL	426004813001,426004813002,426004813007,426004813401	1093790578,1114732559,1114905387,1174845101,1194035436,1265433676,1265523062,1275048217,1275534620,1285635235,1306304027,1326589482,1346386513,1376544320,1386809457,1437295607,1477554814,1508858127,1548248321,1578639126,1629054846,1629219498,1639157415,1730180761,1811246473,1811984636,1841346970,1881679371,1932904927,1972588465,1982799045

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH160058A	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Grinnell	803 Broad Street	Grinnell	IA	Active
DSH160058AA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL EAST - PEDIATRIC SPECIALTY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - OCCUPATIONAL THERAPY	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - CARDIOLOGY Vascular Surg	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - NEUROLOGY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL RADIOLOGY DIAGNOSTIC	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - DIABETES CENTER CLINIC	920 E 2ND AVE	CORALVILLE	IA	ToBeTerminated
DSH160058AG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - DERMATOLOGY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Active
DSH160058AH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - CARDIAC REHABILITATION	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE - REI CLINIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AK	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL - PHYSICAL THERAPY	105 E 9TH ST	CORALVILLE	IA	Terminated
DSH160058AL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - RADIOLOGY DIAGNOSTIC	920 E 2ND AVE	CORALVILLE	IA	ToBeTerminated
DSH160058AM	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - SURGERY CLINIC	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Anticoagulation Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	University of Iowa HEALTH CARE - IRL East - Anesthesia Pain Clinic	920 East 2nd Avenue	Coralville	IA	Active
DSH160058AQ	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - OCCUPATIONAL THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AR	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - RESPIRATORY THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - GASTROENEROLOGY BREATH TESTING	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058AT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - DIGESTIVE DISEASE CENTER	105 E 9TH ST	CORALVILLE	IA	ToBeTerminated
DSH160058AU	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - PHYSICAL THERAPY	920 E 2ND AVE	CORALVILLE	IA	Terminated
DSH160058AV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE RADIOLOGY - DIAGNOSTIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE REI ULTRASOUND	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE OB/GYN ULTRASOUND	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058AY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC ANESTHESIA	105 East 9th Street	Coralville	IA	Active
DSH160058AZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST ANEMIA CLINIC	920 East 2nd Avenue	Coralville	IA	Active
DSH160058B	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Washington	414 East Polk Street	Washington	IA	Active
DSH160058BA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PULM FUNCTION TESTING - IM	105 East 9th Street	Coralville	IA	Active
DSH160058BB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - PEDIATRIC ASSOC NORTH DODGE	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058BC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - PEDIATRIC ASSOC HOLIDAY ROAD	2593 Holiday Road	Coralville	IA	Active
DSH160058BD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC GI MED	105 East 9th Street	Coralville	IA	Active
DSH160058BE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL WOMENS WELLNESS	105 East 9th Street	Coralville	IA	Active
DSH160058BF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HELATH CARE - IRL SURGICAL ONCOLOGY	105 East 9th Street	Coralville	IA	Active
DSH160058BG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - FOOD NUTR SPORTS MED CLINIC	UI SPORTS MEDICINE	IOWA CITY	IA	Terminated
DSH160058BH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PODIATRY	105 East 9th Street	Coralville	IA	Active
DSH160058BJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	MEDICAL CENTER NORTH LIBERTY - ORTHOPEDICS	701 W FOREVERGREEN ROAD	NORTH LIBERTY	IA	Active
DSH160058BK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE- ORTHO TOTAL JOINT	200 HAWKINS DRIVE	IOWA CITY	IA	ToBeTerminated
DSH160058BL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	MEDICAL CENTER NORTH LIBERTY - ORTHOPEDICS WORK INJURY RECOVERY	701 W FOREVERGREEN ROAD	NORTH LIBERTY	IA	Active
DSH160058BM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - PROC ORTHOPEDICS	105 East 9th Street	Coralville	IA	Active
DSH160058BN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE FCC FAMILY MEDICINE	200 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL ORTHOPAEDIC SPORTS MED	105 East 9th Street	Coralville	IA	Active
DSH160058BQ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - AMBUL CARE SPINE TREATMENT CTR	200 HAWKINS DRIVE	IOWA CITY	IA	ToBeTerminated
DSH160058BR	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PEDIATRIC SPECIALTY CLINIC	105 East 9th Street	Coralville	IA	Active
DSH160058BS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL ORTHOPAEDIC PHY MED-REHAB	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058BT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD AUDIOLOGY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BU	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD SPEECH AND LANGUAGE	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTH DODGE OBG IVF PROCEDURES	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058BW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD SOCIAL SERVICES	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD BIO BEHAVIOR SERVICES	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD PSYCHOLOGY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058BZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD PHYSICAL THERAPY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058C	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - Muscatine	3465 Mulberry Avenue	Muscatine	IA	Active
DSH160058CA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD OCCUPATIONAL THERAPY	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD NUTRITION	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD EDUCATION	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - CDD Clinics Outpatient Srvcs	100 HAWKINS DRIVE	IOWA CITY	IA	Active
DSH160058CE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL MED RENAL/HYPERTENSION	105 East 9th Street	Coralville	IA	Active
DSH160058CF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL MED PULMONARY	105 East 9th Street	Coralville	IA	Active
DSH160058CG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL ANE PAIN MANAGEMENT PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL GI SRG PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL INFUSION SUITE	105 East 9th Street	Coralville	IA	Active
DSH160058CK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL WHC GYNECOLOGY PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EYE PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL PROC PHYSIATRY	105 East 9th Street	Coralville	IA	Active
DSH160058CN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL UROLOGY PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CP	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL HVC HEART AND VASCULAR PROCEDURE UNIT	105 East 9th Street	Coralville	IA	Active
DSH160058CQ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST NEU SLEEP - IRL EAST NEU SLEEP	920 East 2nd Avenue	Coralville	IA	Active
DSH160058CR	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL EAST PRESURGICAL EVALUATION CLINIC - IRL EAST PRESURGICAL EVALUATION CLINIC	920 East 2nd Avenue	Coralville	IA	Active
DSH160058CS	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - RADIATION ONCOLOGY QUAD CITIES - RADIATION ONCOLOGY QUAD CITIES	1351 Kimberly Road	Bettendorf	IA	Active
DSH160058CT	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NEU HEADACHE NORTH DODGE - NEU HEADACHE NORTH DODGE	1360 NORTH DODGE STREET	IOWA CITY	IA	Active
DSH160058CU	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - FIRST AVE FAMILY MEDICINE	269 N. 1ST AVE	IOWA CITY	IA	Approved
DSH160058CV	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED PULMONARY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CW	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET GI/HEPATOLOGY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CX	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED INFECTIOUS DISEASE	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058CY	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - TIPTON FAMILY MEDICINE	56 CEDAR ST	TIPTON	IA	Approved
DSH160058CZ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL Diabetes Center Clinical Nutrition	105 East 9th Street	Coralville	IA	Approved
DSH160058D	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Outreach Dialysis - North Liberty	5 Lions Drive	North Liberty	IA	Active
DSH160058DA	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE OBG OBSTETRICS/GYNECOLOGY	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DB	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - OAKDALE PSY PSYCHIATRY	2055 OAKDALE RD	Coralville	IA	Approved
DSH160058DC	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE GENERAL INTERNAL MEDICINE	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DD	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WEST LIBERTY FAMILY MEDICINE	1401 CREES ST	WEST LIBERTY	IA	Approved
DSH160058DE	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - OAKDALE FAMILY MEDICINE	2055 OAKDALE RD	Coralville	IA	Approved
DSH160058DF	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - NORTHGATE DRIVE UROLOGY	2943 NORTHGATE DR	IOWA CITY	IA	Approved
DSH160058DG	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WEST BRANCH FAMILY MEDICINE	206 COOKSON DR	WEST BRANCH	IA	Approved
DSH160058DH	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - MUSCATINE CEDARWOOD DRIVE FAMILY MEDICINE	2104 CEDARWOOD DR	MUSCATINE	IA	Approved
DSH160058DJ	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - WILLIAMSBURG FAMILY MEDICINE	819 S HIGHLAND ST	WILLIAMSBURG	IA	Approved
DSH160058DK	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET SRG ACUTE CARE	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058DL	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - HEARTLAND DRIVE GENERAL PEDIATRICS	2769 HEARTLAND DR	Coralville	IA	Approved
DSH160058DM	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - JEFFERSON STREET MED CARDIOLOGY	540 E. JEFFERSON ST.	IOWA CITY	IA	Approved
DSH160058DN	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - SOLON FAMILY MEDICINE	510 WEST MAIN STREET	SOLON	IA	Approved
DSH160058E	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Sports Medicine Clinic	2701 Prairie Meadow Drive	Iowa City	IA	Active
DSH160058F	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Pediatrics	105 E 9th ST	Coralville	IA	Active
DSH160058G	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Internal Medicine	105 E 9th ST	Coralville	IA	Active
DSH160058H	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Otolaryngology	105 E 9th ST	Coralville	IA	Active
DSH160058J	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Ophthalmology	105 E 9th ST	Coralville	IA	Active
DSH160058K	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	IRL East - GASTROENTEROLOGY CLINIC	920 E 2nd Avenue	Coralville	IA	Active
DSH160058L	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	OB-GYN	105 E 9th ST	Coralville	IA	Active
DSH160058M	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Cardiology	105 E 9th ST	Coralville	IA	Active
DSH160058N	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Dermatology	105 E 9th ST	Coralville	IA	Active
DSH160058P	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	Surgery	105 E 9th Street	Coralville	IA	Terminated
DSH160058Q	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Urology	105 E 9th ST	Coralville	IA	Active
DSH160058R	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	IRL Diabetes Management Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058S	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	Orthopedics	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058T	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL - Procedure Suites	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058U	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	UNIVERSITY OF IOWA HEALTH CARE - IRL East Family Practice Clinic	920 East 2nd Ave	Coralville	IA	Active
DSH160058V	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - QUAD CITIES - CANCER CENTER	1351 KIMBERLY RD STE 100	BETTENDORF	IA	Active
DSH160058W	Child	DSH	UNIVERSITY OF IOWA HOSPITALS & CLINICS	STATE UNIVERSITY OF IOWA - IRL - Family Care Clinic	105 E 9TH ST	CORALVILLE	IA	Terminated
DSH160058X	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Psychiatric Clinic	105 E 9TH ST	CORALVILLE	IA	Active
DSH160058Y	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - NORTH DODGE - OB/GYN CLINIC	1360 N DODGE ST	IOWA CITY	IA	Active
DSH160058Z	Child	DSH	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	STATE UNIVERSITY OF IOWA - IRL - Anesthesia Pain Clinic	105 E 9TH ST	CORALVILLE	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Brownlee, Michael Chief Pharmacy Officer University of Iowa Health Care 3193849371	5/8/2025 11:19 AM
Details	340B ID	Update	New Registration		DSH160058CZ	5/8/2025 11:19 AM
Details	Entity Name	Update	New Registration	UNIVERSITY OF IOWA HEALTH CARE MEDIC	UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER	5/8/2025 11:19 AM
Details	Entity Subname	Update	New Registration	UNIVERSITY OF IOWA HEALTH CARE	UNIVERSITY OF IOWA HEALTH CARE - IRL Diabetes Center Clinical Nutrition	5/8/2025 11:19 AM
Dates	Participating Approval Date	Update	New Registration		5/8/2025 11:19:24 AM	5/8/2025 11:19 AM
Details	State	Update	New Registration	Pending	Approved	5/8/2025 11:19 AM
Dates	Signed By Date	Update	New Registration		4/15/2025 3:50:48 PM	5/8/2025 11:19 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/8/2025 11:19 AM
Addresses	Main Address	Insert	New Registration		105 East 9th Street Coralville, IA 52241	4/15/2025 2:55 PM
Addresses	Billing Address	Insert	New Registration		University of Iowa Accounts Payable 202 PCO Iowa City, IA 52242	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0260927	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0501847	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600585	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0713967	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813001	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813002	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813007	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		426004813401	4/15/2025 2:55 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093790578	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114732559	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114905387	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174845101	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194035436	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265433676	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265523062	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275048217	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275534620	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285635235	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306304027	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326589482	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346386513	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376544320	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1386809457	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437295607	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477554814	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508858127	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548248321	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1578639126	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629054846	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629219498	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1639157415	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730180761	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811246473	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811984636	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1841346970	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881679371	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1932904927	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972588465	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982799045	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1093790578	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114732559	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1114905387	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1174845101	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1194035436	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265433676	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265523062	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275048217	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275534620	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285635235	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306304027	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326589482	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1346386513	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1376544320	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1386809457	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1437295607	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1477554814	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508858127	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548248321	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1578639126	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629054846	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629219498	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1639157415	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730180761	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811246473	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1811984636	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1841346970	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1881679371	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1932904927	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972588465	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1982799045	4/15/2025 2:55 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	4/15/2025 2:55 PM
Contacts	Primary Contact	Insert	New Registration		Triplett, Becky Marie Manager, 340B and Compliance University of Iowa Health Care 3193845583	4/15/2025 2:55 PM
Contacts	Authorizing Official	Insert	New Registration		Brownlee, Michael Chief Pharmacy Officer University of Iowa Health Care 3193849371	4/15/2025 2:55 PM
Details	Assistance Received From Date	Insert	New Registration			4/15/2025 2:55 PM
Details	Assistance Received To Date	Insert	New Registration			4/15/2025 2:55 PM
Details	Last Recertification Date	Insert	New Registration			4/15/2025 2:55 PM
Details	Grant Number	Insert	New Registration			4/15/2025 2:55 PM
Details	340B ID	Insert	New Registration			4/15/2025 2:55 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/15/2025 2:55 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/15/2025 2:55 PM
Details	Medicare Provider Number	Insert	New Registration		160058	4/15/2025 2:55 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF IOWA HEALTH CARE MEDIC	4/15/2025 2:55 PM
Details	NOFO Number	Insert	New Registration			4/15/2025 2:55 PM
Details	Program Code	Insert	New Registration		DSH	4/15/2025 2:55 PM
Details	Entity Subname	Insert	New Registration		UNIVERSITY OF IOWA HEALTH CARE	4/15/2025 2:55 PM
Dates	Participating Approval Date	Insert	New Registration			4/15/2025 2:55 PM
Details	State	Insert	New Registration		Pending	4/15/2025 2:55 PM
Dates	Registration Date	Insert	New Registration		4/15/2025 2:55:04 PM	4/15/2025 2:55 PM
Dates	Signed By Date	Insert	New Registration			4/15/2025 2:55 PM
Dates	Start Date	Insert	New Registration			4/15/2025 2:55 PM
Terminations	Termination Comments	Insert	New Registration			4/15/2025 2:55 PM
Terminations	Termination Date	Insert	New Registration			4/15/2025 2:55 PM
Terminations	Termination Effective Date	Insert	New Registration			4/15/2025 2:55 PM
Terminations	Termination Reason	Insert	New Registration			4/15/2025 2:55 PM