Covered Entity Details

DSH160024 IOWA LUTHERAN HOSPITAL (Terminated) - information as of 4/25/2025 8:31:11 PM

Main Details

Name

IOWA LUTHERAN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH160024

Medicare Provider Number

160024

Additional Details

Current Program Status

Terminated

Registration Date

11/13/2008

Participating Start Date

1/1/2009

Participating Approval Date

11/13/2008

Last Recertification Date

9/3/2018

Termination Date
Termination Reason

10/1/2019
Other

Contacts

Authorizing Official

UnityPoint Des Moines
Eric Lothe, SVP/COO
(515) 241-5858

Primary Contact

UnityPoint Health Des Moines
Brian D. Benson, Executive Director of Pharmacy
(515) 241-3411

Addresses

Street Address

700 EAST UNIVERSITY AVENUE
DES MOINES, IA 50316

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
9/4/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; 8/2/2009- ADDED MEDICAID AND NPI NUMBERS AND UPDATED AUTH. OFFICIAL INFO.	10/19/2009

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	0600247
		1356433049

Shipping Addresses

Shipping Address 1

Lutheran Infusion Pharmacy
Education and Resource Center
1415 Woodland Ave Level 2
Des Moines, IA 50309

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 00359	2545 E EUCLID AVE	DES MOINES	IA	50317	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03773	4600 86TH ST	URBANDALE	IA	50322	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04714	4555 FLEUR DRIVE	DES MOINES	IA	50321	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05060	12753 UNIVERSITY AVE	CLIVE	IA	50325	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05362	1330 E. UNIVERSITY	DES MOINES	IA	50316	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05721	3140 SE 14TH ST	DES MOINES	IA	50320	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07452	4415 DOUGLAS AVE	DES MOINES	IA	50310-2717	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07453	104 E EUCLID AVE	DES MOINES	IA	50313-4507	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07454	901 N ANKENY BLVD	ANKENY	IA	50023-4002	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07996	2702 SE DELAWARE AVE	ANKENY	IA	50021	04/10/2013	07/01/2013	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05777	2930 E. UNIVERSITY AVE.	DES MOINES	IA	50317	07/14/2016	10/01/2016	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07833	3501 INGERSOLL AVE	DES MOINES	IA	50312-3406	07/14/2016	10/01/2016	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05852	3030 UNIVERSITY AVE	DES MOINES	IA	50311	04/13/2017	07/01/2017	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07968	6200 SE 14TH STREET	DES MOINES	IA	50320	04/13/2017	07/01/2017	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03252	606 WALNUT STREET	DES MOINES	IA	50309	07/06/2017	10/01/2017	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04973	7000 DOUGLAS AVE	URBANDALE	IA	50322	07/06/2017	10/01/2017	10/01/2019	10/01/2019
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16528	1704 INGERSOLL AVE STE 102	DES MOINES	IA	50309	07/06/2017	10/01/2017	10/01/2019	10/01/2019
Contract Detail	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/11/2013	07/01/2013	07/01/2015	07/02/2015
Contract Detail	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	04/11/2013	07/01/2013	07/01/2015	07/02/2015

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH160024A	Child	DSH	IOWA LUTHERAN HOSPITAL	Outpatient Infusion Center - MOB	1221 Pleasant Street	Des Moines	IA	Terminated
DSH160024B	Child	DSH	IOWA LUTHERAN HOSPITAL	Blank Infusion Center	1215 Pleasant Street	Des Moines	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		10/1/2019 12:00:00 AM	7/10/2019 1:57 PM
Details	State	Update	Termination Request	Active	To Be Terminated	7/10/2019 1:57 PM
Terminations	Termination Comments	Update	Termination Request		DSH 160024 and DSH160082 are merging under one provider number 160082. CMS letter and attestation provided to OPA	7/10/2019 1:57 PM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/10/2019 1:57 PM
Terminations	Termination Effective Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/10/2019 1:57 PM
Terminations	Termination Reason	Update	Termination Request		Other	7/10/2019 1:57 PM
Contacts	Primary Contact	Update	Profile Change Request	Benson, Brian D. Executive Director of Pharmacy UnityPoint Health 5152413411	Benson, Brian D. Executive Director of Pharmacy UnityPoint Health Des Moines 5152413411	4/15/2019 3:48 PM
Contacts	Primary Contact	Update	Profile Change Request	Benson, Brian D. Executive Director of Pharmacy Iowa Lutheran 5152413411	Benson, Brian D. Executive Director of Pharmacy UnityPoint Health 5152413411	4/15/2019 1:34 PM
Contacts	Authorizing Official	Update	Profile Change Request	Lothe, Eric SVP/COO UnityPoint Des Moines 5152635301	Lothe, Eric SVP/COO UnityPoint Des Moines 5152415858	4/10/2019 12:43 PM
Details	Last Recertification Date	Update	Recertification	11/15/2017 9:00:55 PM	9/3/2018 9:07:31 AM	9/3/2018 9:07 AM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/15/2017 9:00:55 PM	11/15/2017 9:00 PM
Contacts	Authorizing Official	Update		Lothe, Eric SVP/COO 5152635301	Lothe, Eric SVP/COO UnityPoint Des Moines 5152635301	10/13/2017 10:13 AM
Contacts	Primary Contact	Update		Benson, Brian D. Executive Director of Pharmacy 5152413411	Benson, Brian D. Executive Director of Pharmacy Iowa Lutheran 5152413411	9/18/2017 4:50 PM
Contacts	Authorizing Official	Update		Stephenson, Steve Executive VP/COO 5152415858	Lothe, Eric SVP/COO 5152635301	7/21/2017 7:21 PM
Contacts	Primary Contact	Update		Benson, Brian Executive Director Pharmacy 5152413411	Benson, Brian D. Executive Director of Pharmacy 5152413411	7/21/2017 7:21 PM
Addresses	Main Address	Insert			700 EAST UNIVERSITY AVENUE DES MOINES, IA 50316	8/23/2016 4:36 PM
Details	Last Recertification Date	Update		8/6/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 4:36 PM
Addresses	Shipping Address	Insert			Lutheran Infusion Pharmacy Education and Resource Center 1415 Woodland Ave Level 2 Des Moines, IA 50309	8/9/2016 2:20 PM
Contacts	Authorizing Official	Insert			Stephenson, Steve Executive VP/COO 5152415858	7/14/2016 3:25 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/18/2015 8:57 AM
Details	Last Recertification Date	Update		8/7/2014 12:00:00 AM	8/6/2015 12:00:00 AM	8/18/2015 8:57 AM
Contacts	Primary Contact	Update		MEYER, SHARON EXECUTIVE DIRECTOR OF PHARMACY 5152415225	Benson, Brian Executive Director Pharmacy 5152413411	8/7/2014 12:18 PM
Details	Last Recertification Date	Update		8/19/2013 12:00:00 AM	8/7/2014 12:00:00 AM	8/7/2014 12:17 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/19/2013 12:00:00 AM	8/19/2013 10:08 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/16/2012 7:44 AM
Contacts	Primary Contact	Insert			MEYER, SHARON EXECUTIVE DIRECTOR OF PHARMACY 5152415225	10/19/2009 3:03 PM
Details	Last Recertification Date	Insert				10/19/2009 3:03 PM
Details	Grant Number	Insert				10/19/2009 3:03 PM
Details	340B ID	Insert			DSH160024	10/19/2009 3:03 PM
Details	Is Authorizing Official EHB Data	Insert				10/19/2009 3:03 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/19/2009 3:03 PM
Details	Medicare Provider Number	Insert			160024	10/19/2009 3:03 PM
Details	Entity Name	Insert			IOWA LUTHERAN HOSPITAL	10/19/2009 3:03 PM
Details	Program Code	Insert			DSH	10/19/2009 3:03 PM
Details	Entity Subname	Insert				10/19/2009 3:03 PM
Dates	Participating Approval Date	Insert			11/13/2008 12:00:00 AM	10/19/2009 3:03 PM
Details	State	Insert			Active	10/19/2009 3:03 PM
Dates	Registration Date	Insert			11/13/2008 12:00:00 AM	10/19/2009 3:03 PM
Dates	Signed By Date	Insert			10/7/2008 12:00:00 AM	10/19/2009 3:03 PM
Dates	Start Date	Insert			1/1/2009 12:00:00 AM	10/19/2009 3:03 PM
Terminations	Termination Comments	Insert				10/19/2009 3:03 PM
Terminations	Termination Date	Insert				10/19/2009 3:03 PM
Terminations	Termination Effective Date	Insert				10/19/2009 3:03 PM
Terminations	Termination Reason	Insert				10/19/2009 3:03 PM
Details	Comments Public	Insert			9/4/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; 8/2/2009- ADDED MEDICAID AND NPI NUMBERS AND UPDATED AUTH. OFFICIAL INFO.	10/19/2009 3:03 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	11/13/2008 10:06 AM
Medicaid Billing	Medicaid: Number	Insert			0600247	11/13/2008 10:06 AM
Medicaid Billing	Medicaid: State	Insert			IA	11/13/2008 10:06 AM
Medicaid Billing	NPI: Number	Insert			1356433049	11/13/2008 10:06 AM