Covered Entity Details

CAH161306-04 ST. LUKE'S JONES REGIONAL MEDICAL CENTER (Active) - information as of 5/4/2025 10:15:57 PM

Main Details

Name

ST. LUKE'S JONES REGIONAL MEDICAL CENTER

Subdivision Name

UnityPoint Health-Family Medicine Clinic-Tipton - Family Practice

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161306-04

Medicare Provider Number

161306

Outpatient Facility Provider Number

168593

Additional Details

Current Program Status

Active

Registration Date

4/11/2018

Participating Start Date

7/1/2018

Participating Approval Date

6/6/2018

Last Recertification Date

8/21/2024

Contacts

Authorizing Official

St. Luke's Jones Regional Medical Center
ERIC BRIESEMEISTER, CEO
(319) 481-6301

Primary Contact

St. Luke's Jones Regional Medical Center
RACHEL VONBEHREN, DIRECTOR OF FISCAL SERVICES
(319) 481-6302

Addresses

Street Address

1412 Cedar Street
Tipton, IA 52772

Billing Address
Same as Street Address

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?
No

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
CAH161306-01	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health-Family Medicine Clinic-Clarence - Family Practice	411 1st Avenue	Clarence	IA	Active
CAH161306-02	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health Jones Regional Medical Center Anamosa Clinic - Family Practice	1791 Highway 64E	Anamosa	IA	Active
CAH161306-03	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health Jones Regional Medical Center Monticello Clinic - Family Practice	740 E Oak Street	Monticello	IA	Active
CAH161306-04	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health-Family Medicine Clinic-Tipton - Family Practice	1412 Cedar Street	Tipton	IA	Active
CAH161306-05	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health Jones Regional Medical Center Vinton Clinic-Family Practice	1803 C Avenue	Vinton	IA	Active
CAH161306-06	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health Jones Regional Medical Center Belle Plaine Clinic-Family Practice - Family Practice	105 9th Avenue	Belle Plaine	IA	Active
CAH161306-07	Child	CAH	ST. LUKE'S JONES REGIONAL MEDICAL CENTER	UnityPoint Health Jones Regional Medical Center Shellsburg Clinic-Family Practice - Family Practice	131 Main Street	Shellsburg	IA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 4:27:58 PM	8/21/2024 9:24:59 AM	8/21/2024 9:24 AM
Details	Last Recertification Date	Update	Recertification	9/7/2022 9:47:04 AM	8/23/2023 4:27:58 PM	8/23/2023 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/24/2021 10:28:05 AM	9/7/2022 9:47:04 AM	9/7/2022 9:47 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 5:01:07 PM	8/24/2021 10:28:05 AM	8/24/2021 10:28 AM
Details	Last Recertification Date	Update	Recertification	8/29/2019 12:33:58 PM	8/19/2020 5:01:07 PM	8/19/2020 5:01 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1194249920 ( )		8/29/2019 12:33 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 10:24:45 AM	8/29/2019 12:33:58 PM	8/29/2019 12:33 PM
Details	Last Recertification Date	Update	Recertification		8/15/2018 10:24:45 AM	8/15/2018 10:24 AM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		BRIESEMEISTER, ERIC CEO St. Luke's Jones Regional Medical Center 3194816301	6/6/2018 9:31 AM
Details	340B ID	Update	New Registration		CAH161306-04	6/6/2018 9:31 AM
Details	Entity Subname	Update	New Registration	UnityPoint Health-Family Medicine Clinic-Tipton	UnityPoint Health-Family Medicine Clinic-Tipton - Family Practice	6/6/2018 9:31 AM
Dates	Participating Approval Date	Update	New Registration		6/6/2018 9:31:02 AM	6/6/2018 9:31 AM
Details	State	Update	New Registration	Pending	Approved	6/6/2018 9:31 AM
Dates	Signed By Date	Update	New Registration		4/11/2018 11:21:53 AM	6/6/2018 9:31 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	6/6/2018 9:31 AM
Addresses	Main Address	Insert	New Registration		1412 Cedar Street Tipton, IA 52772	4/11/2018 11:21 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1194249920	4/11/2018 11:21 AM
Contacts	Authorizing Official	Insert	New Registration		BRIESEMEISTER, ERIC CEO St. Luke's Jones Regional Medical Center 3194816301	4/11/2018 11:21 AM
Contacts	Primary Contact	Insert	New Registration		VONBEHREN, RACHEL DIRECTOR OF FISCAL SERVICES St. Luke's Jones Regional Medical Center 3194816302	4/11/2018 11:21 AM
Details	Last Recertification Date	Insert	New Registration			4/11/2018 11:21 AM
Details	Grant Number	Insert	New Registration			4/11/2018 11:21 AM
Details	340B ID	Insert	New Registration			4/11/2018 11:21 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2018 11:21 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2018 11:21 AM
Details	Medicare Provider Number	Insert	New Registration		161306	4/11/2018 11:21 AM
Details	Entity Name	Insert	New Registration		ST. LUKE'S JONES REGIONAL MEDICAL CENTER	4/11/2018 11:21 AM
Details	Program Code	Insert	New Registration		CAH	4/11/2018 11:21 AM
Details	Entity Subname	Insert	New Registration		UnityPoint Health-Family Medicine Clinic-Tipton	4/11/2018 11:21 AM
Dates	Participating Approval Date	Insert	New Registration			4/11/2018 11:21 AM
Details	State	Insert	New Registration		Pending	4/11/2018 11:21 AM
Dates	Registration Date	Insert	New Registration		4/11/2018 11:21:50 AM	4/11/2018 11:21 AM
Dates	Signed By Date	Insert	New Registration			4/11/2018 11:21 AM
Dates	Start Date	Insert	New Registration			4/11/2018 11:21 AM
Terminations	Termination Comments	Insert	New Registration			4/11/2018 11:21 AM
Terminations	Termination Date	Insert	New Registration			4/11/2018 11:21 AM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2018 11:21 AM
Terminations	Termination Reason	Insert	New Registration			4/11/2018 11:21 AM