Covered Entity Details

SCH160064-25 MERCYONE NORTH IOWA MEDICAL CENTER (Active) - information as of 5/16/2025 11:29:37 PM

Main Details

Name

MERCYONE NORTH IOWA MEDICAL CENTER

Subdivision Name

MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Weight Loss Ctr

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH160064-25

Medicare Provider Number

160064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2025

Participating Start Date

4/1/2025

Participating Approval Date

3/7/2025

Last Recertification Date

Contacts

Authorizing Official

MercyOne North Iowa Medical Center
Ben Kofoot, VP Operations
(641) 428-7193

Primary Contact

MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024

Addresses

Street Address

910 N Eisenhower Ave
Mason City, IA 50401

Billing Address

MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 10/1/2018, terminated 10/1/2019. Reinstated 4/1/2025.	01/31/2025

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401

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
SCH160064-01	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Women's Health Center	1631 Fourth Street SW	Mason City	IA	Terminated
SCH160064-02	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Northwood Family Medicine	803 9th Avenue North	Northwood	IA	Active
SCH160064-03	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa Dermatology Care	1421 4th Street SW	Mason City	IA	Active
SCH160064-04	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Forest City Family Medicine	635 East Highway 9	Forest City	IA	Active
SCH160064-05	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Forest Park Family Medicine	1010 4th Street Southwest	Mason City	IA	Active
SCH160064-06	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Clear Lake Family Medicine	1410 6th Avenue South	Clear Lake	IA	Active
SCH160064-07	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa Obstetrics and Gynecology	1010 4th Street Southwest	Mason City	IA	Active
SCH160064-08	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Regency Family Medicine	621 South Illinois Avenue	Mason City	IA	Active
SCH160064-09	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Mason City Pediatric & Adolescent Care	910 North Eisenhower Avenue	Mason City	IA	Active
SCH160064-10	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Clear Lake Pediatric & Adolescent Care	401 South 15th Street	Clear Lake	IA	Active
SCH160064-11	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Sheffield Family Medicine	203 South 2nd Street	Sheffield	IA	Active
SCH160064-12	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Rockford Family Medicine	702 East Main Ave	Rockford	IA	Active
SCH160064-13	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Diabetes Ctr	910 N Eisenhower Avenue	Mason City	IA	Active
SCH160064-14	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Kidney Center	910 North Eisenhower Avenue	Mason City	IA	Terminated
SCH160064-15	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Physical Medicine and Rehabilitation	910 N Eisenhower Avenue	Mason City	IA	Active
SCH160064-16	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Lake Mills Family Medicine	505 South 1st Avenue East	Lake Mills	IA	Active
SCH160064-17	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Greene Family Medicine	104 East Traer Street	Greene	IA	Active
SCH160064-18	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Family Clinic - Charles City	1624 South Grand Avenue	Charles City	IA	Terminated
SCH160064-19	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa Heart Center	250 S Crescent Drive	Mason City	IA	Active
SCH160064-20	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Advanced Wound Center and Continence Clinic	1501 4th Street SW	MASON CITY	IA	Terminated
SCH160064-21	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Dialysis Center - Charles City	707 Gilbert Street	Charles City	IA	Terminated
SCH160064-22	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	Mercy Dialysis Center - Mason City	910 N EISENHOWER AVE	MASON CITY	IA	Terminated
SCH160064-23	Child	SCH	MERCY MEDICAL CENTER - NORTH IOWA	MERCY URGENT CARE CLINIC	1631 4TH ST SW	MASON CITY	IA	Terminated
SCH160064-24	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa Family Medicine Residency	1010 4th Street SW	Mason City	IA	Active
SCH160064-25	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Weight Loss Ctr	910 N Eisenhower Ave	Mason City	IA	Active
SCH160064-26	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa Medication Management - Anticoagulation Clinic	621 S ILLINOIS AVE	MASON CITY	IA	Active
SCH160064-27	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Family & Sport Medicine	910 N Eisenhower Ave	Mason City	IA	Active
SCH160064-28	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Bariatric Surgery	910 N Eisenhower Ave	Mason City	IA	Active
SCH160064-29	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Internal Medicine Residency	1010 4th St SW	Mason City	IA	Active
SCH160064-30	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Women’s Health Care and Internal Medicine	1631 Fourth Street SW	Mason City	IA	Active
SCH160064-31	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Neurology	250 S Crescent Dr	Mason City	IA	Active
SCH160064-32	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Neurosurgery	1010 4th Street SW	Mason City	IA	Active
SCH160064-33	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Rheumatology Care	910 N Eisenhower Ave	Mason City	IA	Active
SCH160064-34	Child	SCH	MERCYONE NORTH IOWA MEDICAL CENTER	MercyOne North Iowa - Psychiatry	250 S Crescent Dr	Mason City	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Details	Entity Subname	Update	Change Request	Mercy Bariatric Center - Weight Management Clinic	MercyOne Center for Diabetes, Endocrinology, and Weight Loss - Weight Loss Ctr	3/20/2025 6:30 AM
Contacts	Authorizing Official	Update	Change Request	Trammel, Mark HM VP Finance MercyOne North Iowa Medical Center 6414287984	Kofoot, Ben VP Operations MercyOne North Iowa Medical Center 6414287193	3/18/2025 6:11 AM
Addresses	Billing Address	Insert	Reinstatement		MercyOne North Iowa Medical Center 1000 4th Street SW Mason City, IA 50401	3/7/2025 3:01 PM
Addresses	Shipping Address	Insert	Reinstatement		MercyOne North Iowa Medical Center 1000 4th Street SW Mason City, IA 50401	3/7/2025 3:01 PM
Contacts	Authorizing Official	Update	Reinstatement	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	Trammel, Mark HM VP Finance MercyOne North Iowa Medical Center 6414287984	3/7/2025 3:01 PM
Contacts	Signed By	Update	Reinstatement	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	Trammel, Mark HM VP Finance MercyOne North Iowa Medical Center 6414287984	3/7/2025 3:01 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	9/30/2019 12:00:00 AM		3/7/2025 3:01 PM
Details	Entity Name	Update	Reinstatement	MERCY MEDICAL CENTER - NORTH IOWA	MERCYONE NORTH IOWA MEDICAL CENTER	3/7/2025 3:01 PM
Dates	Participating Approval Date	Update	Reinstatement	9/5/2018 8:21:31 AM	3/7/2025 3:01:31 PM	3/7/2025 3:01 PM
Details	State	Update	Reinstatement	Terminated	Approved	3/7/2025 3:01 PM
Dates	Registration Date	Update	Reinstatement	9/4/2018 2:37:00 PM	1/6/2025 3:57:28 PM	3/7/2025 3:01 PM
Dates	Signed By Date	Update	Reinstatement	9/4/2018 2:38:48 PM	1/10/2025 1:10:32 PM	3/7/2025 3:01 PM
Dates	Start Date	Update	Reinstatement	10/1/2018 12:00:00 AM	4/1/2025 12:00:00 AM	3/7/2025 3:01 PM
Terminations	Termination Comments	Update	Reinstatement	Termination as SCH 10/1/19; Reinstated as DSH 10/1/19.		3/7/2025 3:01 PM
Terminations	Termination Date	Update	Reinstatement	10/1/2019 12:00:00 AM		3/7/2025 3:01 PM
Terminations	Termination Effective Date	Update	Reinstatement	9/30/2019 12:00:00 AM		3/7/2025 3:01 PM
Terminations	Termination Reason	Update	Reinstatement	Other		3/7/2025 3:01 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 10/1/2018, terminated 10/1/2019. Reinstated 4/1/2025.	1/31/2025 12:14 PM
Contacts	Primary Contact	Update	Profile Change Request	Brownmiller, Erin 340B Program Supervisor MercyOne North Iowa Medical Center 6414287024	Brownmiller, Erin 340B Program Manager MercyOne North Iowa Medical Center 6414287024	10/13/2021 11:18 AM
Contacts	Primary Contact	Update	Profile Change Request	Brownmiller, Erin 340B Program Coordinator MercyOne North Iowa Medical Center 6414287024	Brownmiller, Erin 340B Program Supervisor MercyOne North Iowa Medical Center 6414287024	1/13/2020 3:33 PM
Contacts	Authorizing Official	Update	Profile Change Request	ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	10/15/2019 1:05 PM
Contacts	Signed By	Update	Profile Change Request	ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	ZOOK, DANETTE RHM VP Finance MercyOne North Iowa Medical Center 6414287989	10/15/2019 1:05 PM
Details	State	Update		To Be Terminated	Terminated	10/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	7/11/2019 12:00:00 AM	9/30/2019 12:00:00 AM	7/11/2019 4:24 PM
Details	State	Update	OPA Edit Termination Info	Terminated	To Be Terminated	7/11/2019 4:24 PM
Terminations	Termination Date	Update	OPA Edit Termination Info	7/11/2019 12:00:00 AM	10/1/2019 12:00:00 AM	7/11/2019 4:24 PM
Terminations	Termination Effective Date	Update	OPA Edit Termination Info	7/9/2019 12:00:00 AM	9/30/2019 12:00:00 AM	7/11/2019 4:24 PM
Contacts	Primary Contact	Update	Reinstatement	Brownmiller, Erin 340B Program Coordinator Mercy Medical Center - North Iowa 6414287024	Brownmiller, Erin 340B Program Coordinator MercyOne North Iowa Medical Center 6414287024	7/11/2019 12:10 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Edit Termination Info	9/30/2019 12:00:00 AM	7/11/2019 12:00:00 AM	7/11/2019 11:19 AM
Details	State	Update	OPA Edit Termination Info	To Be Terminated	Terminated	7/11/2019 11:19 AM
Terminations	Termination Date	Update	OPA Edit Termination Info	10/1/2019 12:00:00 AM	7/11/2019 12:00:00 AM	7/11/2019 11:19 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		9/30/2019 12:00:00 AM	7/11/2019 11:16 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/11/2019 11:16 AM
Terminations	Termination Comments	Update	Termination Request		Termination as SCH 10/1/19; Reinstated as DSH 10/1/19.	7/11/2019 11:16 AM
Terminations	Termination Date	Update	Termination Request		10/1/2019 12:00:00 AM	7/11/2019 11:16 AM
Terminations	Termination Effective Date	Update	Termination Request		7/9/2019 12:00:00 AM	7/11/2019 11:16 AM
Terminations	Termination Reason	Update	Termination Request		Other	7/11/2019 11:16 AM
Details	State	Update		Approved	Active	10/1/2018 12:05 AM
Details	Entity Name	Update	Change Request	MERCY MEDICAL CENTER - MASON CITY	MERCY MEDICAL CENTER - NORTH IOWA	9/7/2018 4:10 PM
Contacts	Signed By	Insert	New Registration		ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	9/5/2018 8:21 AM
Details	340B ID	Update	New Registration		SCH160064-25	9/5/2018 8:21 AM
Details	Entity Subname	Update	New Registration	Mercy Bariatric Center	Mercy Bariatric Center - Weight Management Clinic	9/5/2018 8:21 AM
Dates	Participating Approval Date	Update	New Registration		9/5/2018 8:21:31 AM	9/5/2018 8:21 AM
Details	State	Update	New Registration	Pending	Approved	9/5/2018 8:21 AM
Dates	Signed By Date	Update	New Registration		9/4/2018 2:38:48 PM	9/5/2018 8:21 AM
Dates	Start Date	Update	New Registration		10/1/2018 12:00:00 AM	9/5/2018 8:21 AM
Addresses	Main Address	Insert	New Registration		910 N Eisenhower Ave Mason City, IA 50401	9/4/2018 2:37 PM
Addresses	Billing Address	Insert	New Registration		Mercy Medical Center - North Iowa 1000 4th Street SW Mason City, IA 50401	9/4/2018 2:37 PM
Contacts	Primary Contact	Insert	New Registration		Brownmiller, Erin 340B Program Coordinator Mercy Medical Center - North Iowa 6414287024	9/4/2018 2:37 PM
Contacts	Authorizing Official	Insert	New Registration		ZOOK, DANETTE RHM VP Finance Mercy Medical Center - North Iowa 6414287989	9/4/2018 2:37 PM
Details	Last Recertification Date	Insert	New Registration			9/4/2018 2:37 PM
Details	Grant Number	Insert	New Registration			9/4/2018 2:37 PM
Details	340B ID	Insert	New Registration			9/4/2018 2:37 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			9/4/2018 2:37 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			9/4/2018 2:37 PM
Details	Medicare Provider Number	Insert	New Registration		160064	9/4/2018 2:37 PM
Details	Entity Name	Insert	New Registration		MERCY MEDICAL CENTER - MASON CITY	9/4/2018 2:37 PM
Details	Program Code	Insert	New Registration		SCH	9/4/2018 2:37 PM
Details	Entity Subname	Insert	New Registration		Mercy Bariatric Center	9/4/2018 2:37 PM
Dates	Participating Approval Date	Insert	New Registration			9/4/2018 2:37 PM
Details	State	Insert	New Registration		Pending	9/4/2018 2:37 PM
Dates	Registration Date	Insert	New Registration		9/4/2018 2:37:00 PM	9/4/2018 2:37 PM
Dates	Signed By Date	Insert	New Registration			9/4/2018 2:37 PM
Dates	Start Date	Insert	New Registration			9/4/2018 2:37 PM
Terminations	Termination Comments	Insert	New Registration			9/4/2018 2:37 PM
Terminations	Termination Date	Insert	New Registration			9/4/2018 2:37 PM
Terminations	Termination Effective Date	Insert	New Registration			9/4/2018 2:37 PM
Terminations	Termination Reason	Insert	New Registration			9/4/2018 2:37 PM