340B Drug Pricing Program Database


DSH160082 IOWA METHODIST MEDICAL CENTER (Active) - information as of 4/25/2025 10:09:41 PM

Main Details
IOWA METHODIST MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH160082
160082


Additional Details
Active
4/13/2017
7/1/2017
4/28/2017
8/23/2024

Contacts

UnityPoint Health - Des Moines
Jon Rozenfeld, Market President
(515) 241-6396

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

Addresses

1200 PLEASANT STREET
DES MOINES, IA 50309

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
SECOND REQUEST - Please answer OPA's questions from 5/21/2105/24/2021
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IA06008251396837951,1356433049,1598905762
IL 1356433049,1396837951,1598905762
Shipping Addresses

IMMC Outpatient Pharmacy
1200 Pleasant Street
Des Moines, IA 50309

Iowa Methodist Med Ctr
1200 Pleasant St.
Des Moines, IA 50309

UnityPoint Health - Des Moines Cardiac and Pulmonary Rehab
6000 University Ave
Suite A15
West Des Moines, IA 50266

UnityPoint Health -Des Moines Cardiology and Cardiac Arrythmia Center
1215 Pleasant Street
Suite 414
Des Moines, IA 50309-1408

UnityPoint Health - Des Moines Cardiology Penn Ave
1302 Pennsylvania Ave
Suite 100
Des Moines, IA 50316-2364

UnityPoint Health - Des Moines Cardiology Lakeview
6000 Univesity Avenue
Suite A20
West Des Moines, IA 50266-8200

UnityPoint Health - Des Moines Neurology and Infectious Disease Methodist Plaza
1221 Pleasant Street
Suite 300
Des Moines, IA 50309-1426

UnityPoint Health - Des Moines Neurology Lakeview
6000 University Avenue
Suite 210
West Des Moines, IA 50266-8201

Ankeny Medical Park Pharmacy
3625 N Ankeny BLVD
Suite A
Ankeny, IA 50023
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailANKENY MEDICAL PARK PHARMACY3625 N ANKENY BLVD SUITE A
ANKENYIA5002301/13/202504/01/2025  04/01/2025
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503307/12/201710/01/2017  07/21/2017
Contract DetailFAIRVIEW SPECIALTY SERVICES PHARMACY711 KASOTA AVENUE SE, SUITE A
MINNEAPOLISMN5541410/11/202201/01/2023  01/01/2023
Contract DetailGRX HOLDINGS, LLCMEDICAP PHARMACY 250 SE GATEWAY DRIVE
GRIMESIA5011110/11/202201/01/2023  01/01/2023
Contract DetailGRX HOLDINGS, LLCMEDICAP PHARMACY 504 14TH STREET
PO BOX 369 		DALLAS CENTERIA50063-207510/11/202201/01/2023 03/05/202504/06/2025
Contract DetailGRX HOLDINGS, LLC DBA MEDICAP PHARMACY107 NE DELAWARE AVE STE 6
ANKENYIA50021-669110/11/202201/01/2023  01/01/2023
Contract DetailHY VEE PHARMACY1107 E ARMY POST RD
DES MOINESIA5031507/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE DRUGSTORE PHARMACY #70314100 UNIVERSITY AVENUE
DES MOINESIA5031107/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE FOOD & DRUG #2HY-VEE FOOD STORES INC 2540 E EUCLID AVENUE
DES MOINESIA5031707/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE PHACY #11363330 MARTIN LUTHER KING JR PKY
DES MOINESIA5031007/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE PHARMACY3221 SE 14TH ST
DES MOINESIA5032007/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE PHARMACY4605 FLEUR DR
DES MOINESIA5032107/06/201710/01/2017 04/01/201905/14/2019
Contract DetailHY-VEE PHARMACY FULFILLMENT CENTER 4016HY-VEE INC 4707 FLUER DR
DES MOINESIA5032107/06/201710/01/2017 04/01/201905/14/2019
Contract DetailMEDICAP PHARMACYGRX HOLDINGS, LLC 2804 BEAVER AVENUE
DES MOINESIA5031010/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYMEDICAP PHARMACY 8170 DOUGLAS AVE
URBANDALEIA5032210/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS LLC 1300 EAST 14TH STREET
DES MOINESIA5031610/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS LLC 950 28TH AVE SW
SUITE 1 		ALTOONAIA50009-194010/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS, LLC 10 S. WARRIOR LANE
WAUKEEIA5026310/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS, LLC 2527 EASTON BLVD
DES MOINESIA5031710/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS, LLC 904 N JOHN WAYNE DR
WINTERSETIA5027310/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX NORWALK, INC. 2521 SUNSET DRIVE
SUITE 1 		NORWALKIA5021110/11/202201/01/2023 04/03/202307/06/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS LLC 2105 N 3RD LN
INDIANOLAIA5012510/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS LLC 800 SCHOOL STREET
CARLISLEIA5004710/11/202201/01/2023  01/01/2023
Contract DetailMEDICAP PHARMACYGRX HOLDINGS, LLC 2301 SUNSET DR STE A
NORWALKIA5021107/17/202308/07/2023  08/30/2023
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/12/201710/01/2017 08/31/202207/25/2024
Contract DetailUNITYPOINT AT HOME11333 AURORA AVE
URBANDALEIA5032210/16/201701/01/2018  10/16/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05852 3030 UNIVERSITY AVE
DES MOINESIA5031107/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07967 15601 HICKMAN RD
CLIVEIA5032507/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07968 6200 SE 14TH STREET
DES MOINESIA5032007/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06623 1660 22ND STREET
WEST DES MOINESIA5026607/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 09791 101 8TH ST SE
ALTOONAIA50009-193807/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05777 2930 E. UNIVERSITY AVE.
DES MOINESIA5031707/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05362 1330 E. UNIVERSITY
DES MOINESIA5031607/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04973 7000 DOUGLAS AVE
URBANDALEIA5032207/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07453 104 E EUCLID AVE
DES MOINESIA50313-450707/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05944 6200 MERLE HAY ROAD
JOHNSTONIA5013107/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06678 1999 GRAND AVE
WEST DES MOINESIA5026507/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07996 2702 SE DELAWARE AVE
ANKENYIA5002107/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05943 1000 N JEFFERSON WAY
INDIANOLAIA5012507/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05721 3140 SE 14TH ST
DES MOINESIA5032007/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 05060 12753 UNIVERSITY AVE
CLIVEIA5032507/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 00359 2545 E EUCLID AVE
DES MOINESIA5031707/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07833 3501 INGERSOLL AVE
DES MOINESIA50312-340607/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 04714 4555 FLEUR DRIVE
DES MOINESIA5032107/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03773 4600 86TH ST
URBANDALEIA5032207/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07452 4415 DOUGLAS AVE
DES MOINESIA50310-271707/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 07454 901 N ANKENY BLVD
ANKENYIA50023-400207/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 06677 4900 MILLS CIVIC PARKWAY
WEST DES MOINESIA5026507/12/201710/01/2017  07/21/2017
Contract DetailWALGREEN CO.DBA: WALGREENS # 03252 606 WALNUT STREET
DES MOINESIA5030910/13/202001/01/2021 02/26/202402/26/2024
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #16528 1704 INGERSOLL AVE STE 102
DES MOINESIA5030907/12/202110/01/2021  10/01/2021
Contract DetailWalgreens Central Fill #213942601 Hughes Road
Suite 103 		LibertyMO6406801/03/202304/01/2023  04/01/2023
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/12/201710/01/2017  07/21/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/12/201710/01/2017 10/01/202110/18/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/12/201710/01/2017  07/21/2017
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/12/201710/01/2017  07/21/2017
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH160082AChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION /Maternity Unit -West - 30150001660 60TH STREETWEST DES MOINESIAActive
DSH160082AAChildDSHIOWA METHODIST MEDICAL CENTERInfusion Center - Infusion Center - Meth - 20240001221 Pleasant StreetDes MoinesIAActive
DSH160082ABChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Recovery - Ambulatory Surgery - 1020100700 East University AvenueDes MoinesIAActive
DSH160082ACChildDSHIOWA METHODIST MEDICAL CENTERBlank Children's Infusion Center - BIC - 20240101215 Pleasant StreetDes MoinesIAActive
DSH160082ADChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Psychiatric Services - 1012300700 East University AvenueDes MoinesIATerminated
DSH160082AEChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Cardiac Rehabilitation - 1034200700 East University AvenueDes MoinesIAActive
DSH160082AFChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Renal Dialysis - 1026100700 East University AvenueDes MoinesIAActive
DSH160082AGChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Access Center - ED - 1031600700 East University AvenueDes MoinesIAActive
DSH160082AHChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Vascular Lab - 1022600700 East University AvenueDes MoinesIAActive
DSH160082AJChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Mammography -Luth - 1022700700 East University AvenueDes MoinesIAActive
DSH160082AKChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Nuclear Medicine - Luth - 1022400700 East University AvenueDes MoinesIAActive
DSH160082ALChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Outpt Pediatric MH - Luth - 1031200700 East University AvenueDes MoinesIAActive
DSH160082AMChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Ambulatory Surgery - 1020120700 East University AvenueDes MoinesIATerminated
DSH160082ANChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - CT Scan - 1022100700 East University AvenueDes MoinesIAActive
DSH160082APChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Respiratory Care - LUTH - 1035000700 East University AvenueDes MoinesIAActive
DSH160082AQChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - ILH Therapy OP - 1028310700 East University AvenueDes MoinesIAActive
DSH160082ARChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Echocardiography - Luth - 1034010700 East University AvenueDes MoinesIAActive
DSH160082ASChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital -Surgery - LUTH - 1020000700 East University AvenueDes MoinesIAActive
DSH160082ATChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Radiology - 1022200700 East University AvenueDes MoinesIAActive
DSH160082AUChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Emergency Department - Luth - 1033000700 East University AvenueDes MoinesIAActive
DSH160082AVChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Cardiac Cath Lab - 1034100700 East University AvenueDes MoinesIAActive
DSH160082AWChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Infusion Center- Luth - 1024000700 East University AvenueDes MoinesIAActive
DSH160082AXChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Adult Partial Hospitalization - 1031430700 East University AvenueDes MoinesIAActive
DSH160082AYChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - ILH Therapy - 1028300700 East University AvenueDes MoinesIAActive
DSH160082AZChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Endoscopy - Luth - 1020400700 East University AvenueDes MoinesIAActive
DSH160082BChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Emergency 30330001660 60TH StreetWEST DES MOINESIAActive
DSH160082BAChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - MRI - Luth - 1022300700 East University AvenueDes MoinesIAActive
DSH160082BBChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Recovery Room PACU LUTH - 1020200700 East University AvenueDes MoinesIAActive
DSH160082BCChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - EKG-LUTH - 1034000700 East University AvenueDes MoinesIAActive
DSH160082BDChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Electroencephalography - 1032000700 East University AvenueDes MoinesIAActive
DSH160082BEChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - ECT - 1031710700 East University AvenueDes MoinesIAActive
DSH160082BFChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Powell CDC - 1031000700 East University AvenueDes MoinesIAActive
DSH160082BGChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - Blank Pediatric Gastroenterology 20434001215 PLEASANT STREETDES MOINESIAActive
DSH160082BHChildDSHIOWA METHODIST MEDICAL CENTERUNITYPOINT HEALTH - DES MOINES BLAN - Blank Pediatric Pulmonology 20431001212 PLEASANT STREETDES MOINESIAActive
DSH160082BJChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - Blank Pediatric Endocrinology - 20436001215 Pleasant StreetDes MoinesIAActive
DSH160082BKChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology - Lakeview 20430106000 UNIVERSITY AVENUEWEST DES MOINESIAActive
DSH160082BLChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology and Cardiac Arrythmia - Plaza 20430001215 PLEASANT STREETDES MOINESIAActive
DSH160082BMChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines Infectious Disease - Plaza 20439001221 PLEASANT STREETDES MOINESIAActive
DSH160082BNChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Neurology - Plaza 20432001221 PLEASANT ST STE 300DES MOINESIAActive
DSH160082BPChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology - Penn Ave 10430001301 PENNSYLVANIA AVENUEDES MOINESIAActive
DSH160082BQChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Neurology - Lakeview 20432006000 UNIVERSITY AVENUEWEST DES MOINESIAActive
DSH160082BRChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Pediatrics - 20415001212 PLEASANT ST STE 300DES MOINESIAActive
DSH160082BSChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORP - UnityPoint Health - Des Moines Blank Children's Psychiatry - 20447001206 PLEASANT STDES MOINESIAActive
DSH160082BTChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Diagnostics - 20439201212 PLEASANT ST STE 300DES MOINESIAActive
DSH160082BUChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Palliative Care - 20383201212 PLEASANT ST STE 300DES MOINESIAActive
DSH160082BVChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Orthopaedics - 20424101215 PLEASANT STREETDES MOINESIAActive
DSH160082BWChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines Blank Children's Neurology 20432101215 PLEASANT ST STE 303DES MOINESIAActive
DSH160082BXChildDSHIOWA METHODIST MEDICAL CENTERCentral Iowa Hospital Corporation - UnityPoint Health - Des Moines Medication Therapy Management - 20233001212 Pleasant StreetDes MoinesIAActive
DSH160082BYChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - Counseling and Psychiatry - Lakeview 30445006000 UNIVERSITY AVE STE 200WEST DES MOINESIAActive
DSH160082BZChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION - Behavioral Health Urgent Care - 10446201250 E 9TH STDES MOINESIAActive
DSH160082CChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION /Surgery-West 30200001660 60TH STREETWEST DES MOINESIAActive
DSH160082CAChildDSHIOWA METHODIST MEDICAL CENTERUNITYPOINT HEALTH - DES MOINES BLAN - Children's Treatment/Surgery Room - 20209201206 PLEASANT STDES MOINESIAActive
DSH160082DChildDSHIOWA METHODIST MEDICAL CENTERIOWA METHODIST HAND CLINIC6001 WESTOWN PKWY #101WEST DES MOINESIATerminated
DSH160082EChildDSHIOWA METHODIST MEDICAL CENTERJOHN STODDARD CANCER CENTER - 20270301221 PLEASANT STREETDES MOINESIAActive
DSH160082FChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Eye Surgery Center - 20201101300 37TH STREETWEST DES MOINESIAActive
DSH160082GChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Wound Healing Center1215 PLEASANT STDES MOINESIATerminated
DSH160082HChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / EEG-West - 30320001660 60TH STREETWEST DES MOINESIAActive
DSH160082JChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Echocardiography - West 30340101660 60TH STREETWEST DES MOINESIAActive
DSH160082KChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Therapy Services MWH - West 30283001660 60TH STREETWEST DES MOINESIAActive
DSH160082LChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / EKG-West 30340001660 60TH STREETWEST DES MOINESIAActive
DSH160082MChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION /Respiratory Care-West 30350001660 60TH STREETWEST DES MOINESIAActive
DSH160082NChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Blood Bank1660 60TH STWEST DES MOINESIATerminated
DSH160082PChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Laboratory1660 60TH STWEST DES MOINESIATerminated
DSH160082QChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / MRI - West 30223001660 60TH STREETWEST DES MOINESIAActive
DSH160082RChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / CT SCAN -WEST 30221001660 60TH STREETWEST DES MOINESIAActive
DSH160082SChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Ultrasound - West 30225001660 60TH STREETWEST DES MOINESIAActive
DSH160082TChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Nuclear Medicine West - 30224001660 60TH STREETWEST DES MOINESIAActive
DSH160082UChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION /General Radiology - West 30222001660 60TH STREETWEST DES MOINESIAActive
DSH160082VChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / PACU - West - 30202001660 60TH STREETWEST DES MOINESIAActive
DSH160082WChildDSHIOWA METHODIST MEDICAL CENTERCENTRAL IOWA HOSPITAL CORPORATION / Surgery -West 30200001660 60TH STREETWEST DES MOINESIAActive
DSH160082XChildDSHIOWA METHODIST MEDICAL CENTERCentral Iowa Hospital Corporation/ Orthopedics 3-West 30106101660 60th StreetWest Des MoinesIAActive
DSH160082YChildDSHIOWA METHODIST MEDICAL CENTERCentral Iowa Hospital Corporation/ Med/Surg 4- West 30107101660 60th StreetWest Des MoinesIAActive
DSH160082ZChildDSHIOWA METHODIST MEDICAL CENTERIowa Lutheran Hospital - Ultrasound - Luth- 1022500700 East University AvenueDes MoinesIAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Ankeny Medical Park Pharmacy 3625 N Ankeny BLVD Suite A Ankeny, IA 500234/7/2025 6:58 AM
ContactsAuthorizing OfficialUpdateChange RequestJaeger, Paige L Vice President, Operations UnityPoint Health Des Moines 5152414422Rozenfeld, Jon Market President UnityPoint Health - Des Moines 51524163963/25/2025 7:28 AM
ContactsAuthorizing OfficialUpdateChange RequestMulrooney, Thomas P Chief Operating Officer UnityPoint Health 5152414027Jaeger, Paige L Vice President, Operations UnityPoint Health Des Moines 51524144221/2/2025 3:36 PM
DetailsLast Recertification DateUpdateRecertification8/17/2023 1:48:26 PM8/23/2024 7:14:19 AM8/23/2024 7:14 AM
DetailsLast Recertification DateUpdateRecertification8/26/2022 3:02:21 PM8/17/2023 1:48:26 PM8/17/2023 1:48 PM
Medicaid BillingNPI: NumberDeleteChange Request1356433049 (MO) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1396837951 (MO) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1598905762 (MO) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1356433049 (MN) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1396837951 (MN) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1598905762 (MN) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1356433049 (NE) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1396837951 (NE) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request1598905762 (NE) 6/14/2023 4:55 PM
Medicaid BillingNPI: NumberDeleteChange Request9000176831 (CO) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1770871824 (ID) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1144309188 (MI) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1770871824 (MI) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1770871824 (NC) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1770871824 (NM) 3/19/2023 4:17 PM
Medicaid BillingNPI: NumberDeleteChange Request1770871824 (OR) 3/19/2023 4:17 PM
ContactsAuthorizing OfficialUpdateChange RequestLothe, Eric SVP/COO UnityPoint Des Moines 5152415858Mulrooney, Thomas P Chief Operating Officer UnityPoint Health 515241402712/13/2022 11:19 AM
DetailsLast Recertification DateUpdateRecertification8/23/2021 10:06:33 AM8/26/2022 3:02:21 PM8/26/2022 3:02 PM
Medicaid BillingNPI: NumberInsertChange Request 13564330496/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MO6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13968379516/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MO6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 15989057626/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MO6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13564330496/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MN6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13968379516/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MN6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 15989057626/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request MN6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13564330496/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request IL6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13968379516/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request IL6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 15989057626/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request IL6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13564330496/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request NE6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 13968379516/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request NE6/16/2022 3:39 PM
Medicaid BillingNPI: NumberInsertChange Request 15989057626/16/2022 3:39 PM
Medicaid BillingNPI: StateInsertChange Request NE6/16/2022 3:39 PM
DetailsLast Recertification DateUpdateRecertification8/21/2020 10:01:31 AM8/23/2021 10:06:33 AM8/23/2021 10:06 AM
AddressesShipping AddressInsertChange Request UnityPoint Health - Des Moines Cardiac and Pulmonary Rehab 6000 University Ave Suite A15 West Des Moines, IA 502666/21/2021 9:48 AM
AddressesShipping AddressInsertChange Request UnityPoint Health -Des Moines Cardiology and Cardiac Arrythmia Center 1215 Pleasant Street Suite 414 Des Moines, IA 50309-14086/21/2021 9:48 AM
AddressesShipping AddressInsertChange Request UnityPoint Health - Des Moines Cardiology Penn Ave 1302 Pennsylvania Ave Suite 100 Des Moines, IA 50316-23646/21/2021 9:48 AM
AddressesShipping AddressInsertChange Request UnityPoint Health - Des Moines Cardiology Lakeview 6000 Univesity Avenue Suite A20 West Des Moines, IA 50266-82006/21/2021 9:48 AM
AddressesShipping AddressInsertChange Request UnityPoint Health - Des Moines Neurology and Infectious Disease Methodist Plaza 1221 Pleasant Street Suite 300 Des Moines, IA 50309-14266/21/2021 9:48 AM
AddressesShipping AddressInsertChange Request UnityPoint Health - Des Moines Neurology Lakeview 6000 University Avenue Suite 210 West Des Moines, IA 50266-82016/21/2021 9:48 AM
DetailsComments PublicInsertChange Request SECOND REQUEST - Please answer OPA's questions from 5/21/215/24/2021 7:02 PM
Medicaid BillingNPI: NumberInsertRecertification 13968379518/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification IA8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 13564330498/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification IA8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 15989057628/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification IA8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 90001768318/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification CO8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 17708718248/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification ID8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 11443091888/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification MI8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 17708718248/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification MI8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 17708718248/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification NC8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 17708718248/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification NM8/21/2020 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 17708718248/21/2020 10:01 AM
Medicaid BillingNPI: StateInsertRecertification OR8/21/2020 10:01 AM
Medicaid BillingNPI: NumberDeleteRecertification1396837951 ( ) 8/21/2020 10:01 AM
DetailsLast Recertification DateUpdateRecertification8/21/2019 9:33:45 AM8/21/2020 10:01:31 AM8/21/2020 10:01 AM
AddressesShipping AddressInsertChange Request Iowa Methodist Med Ctr 1200 Pleasant St. Des Moines, IA 503094/9/2020 12:34 PM
DetailsLast Recertification DateUpdateRecertification9/3/2018 9:08:20 AM8/21/2019 9:33:45 AM8/21/2019 9:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/9/2019 12:14 PM
Medicaid BillingMedicaid: NumberInsertChange Request 06008257/9/2019 12:14 PM
Medicaid BillingMedicaid: StateInsertChange Request IA7/9/2019 12:14 PM
ContactsPrimary ContactUpdateProfile Change RequestBenson, Brian D. Executive Director of Pharmacy UnityPoint Health 5152413411Benson, Brian D. Executive Director of Pharmacy UnityPoint Health Des Moines 51524134114/15/2019 3:48 PM
ContactsPrimary ContactUpdateProfile Change RequestBenson, Brian D. Executive Director of Pharmacy Iowa Lutheran 5152413411Benson, Brian D. Executive Director of Pharmacy UnityPoint Health 51524134114/15/2019 1:34 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestLothe, Eric SVP/COO UnityPoint Des Moines 5152635301Lothe, Eric SVP/COO UnityPoint Des Moines 51524158584/10/2019 12:43 PM
ContactsSigned ByUpdateProfile Change RequestLothe, Eric SVP/COO UnityPoint Des Moines 5152635301Lothe, Eric SVP/COO UnityPoint Des Moines 51524158584/10/2019 12:43 PM
DetailsLast Recertification DateUpdateRecertification11/7/2017 10:00:08 AM9/3/2018 9:08:20 AM9/3/2018 9:08 AM
DetailsLast Recertification DateUpdateRecertification 11/7/2017 10:00:08 AM11/7/2017 10:00 AM
ContactsAuthorizing OfficialUpdate Lothe, Eric SVP/COO 5152635301Lothe, Eric SVP/COO UnityPoint Des Moines 515263530110/13/2017 10:13 AM
ContactsSigned ByUpdate Lothe, Eric SVP/COO 5152635301Lothe, Eric SVP/COO UnityPoint Des Moines 515263530110/13/2017 10:13 AM
ContactsPrimary ContactUpdate Benson, Brian D. Executive Director of Pharmacy 5152413411Benson, Brian D. Executive Director of Pharmacy Iowa Lutheran 51524134119/18/2017 4:50 PM
ContactsAuthorizing OfficialInsert  Lothe, Eric SVP/COO 51526353017/21/2017 7:21 PM
ContactsSigned ByInsert  Lothe, Eric SVP/COO 51526353017/21/2017 7:21 PM
ContactsPrimary ContactInsert  Benson, Brian D. Executive Director of Pharmacy 51524134117/21/2017 7:21 PM
AddressesMain AddressInsert   1200 PLEASANT STREET DES MOINES, IA 503097/21/2017 7:21 PM
AddressesShipping AddressInsert  IMMC Outpatient Pharmacy 1200 Pleasant Street Des Moines, IA 503097/21/2017 7:21 PM
DatesParticipating Approval DateUpdate  4/28/2017 12:00:00 AM4/28/2017 12:57 PM
DetailsStateUpdate PendingActive4/28/2017 12:57 PM
DatesStart DateUpdate  7/1/2017 12:00:00 AM4/28/2017 12:57 PM
Details340B IDUpdate ONLINE_REG_76837DSH1600824/27/2017 3:33 PM
Details340B IDUpdate  ONLINE_REG_768374/13/2017 10:20 AM
Medicaid BillingNPI: NumberInsert  13968379514/13/2017 10:20 AM
DetailsLast Recertification DateInsert   4/13/2017 10:20 AM
DetailsGrant NumberInsert   4/13/2017 10:20 AM
Details340B IDInsert   4/13/2017 10:20 AM
DetailsIs Authorizing Official EHB DataInsert   4/13/2017 10:20 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/13/2017 10:20 AM
DetailsMedicare Provider NumberInsert  1600824/13/2017 10:20 AM
DetailsEntity NameInsert  IOWA METHODIST MEDICAL CENTER4/13/2017 10:20 AM
DetailsProgram CodeInsert  DSH4/13/2017 10:20 AM
DetailsEntity SubnameInsert   4/13/2017 10:20 AM
DatesParticipating Approval DateInsert   4/13/2017 10:20 AM
DetailsStateInsert  Pending4/13/2017 10:20 AM
DatesRegistration DateInsert  4/13/2017 12:00:00 AM4/13/2017 10:20 AM
DatesSigned By DateInsert  4/13/2017 12:00:00 AM4/13/2017 10:20 AM
DatesStart DateInsert   4/13/2017 10:20 AM
TerminationsTermination CommentsInsert   4/13/2017 10:20 AM
TerminationsTermination DateInsert   4/13/2017 10:20 AM
TerminationsTermination Effective DateInsert   4/13/2017 10:20 AM
TerminationsTermination ReasonInsert   4/13/2017 10:20 AM