Covered Entity Details

DSH160082AJ IOWA METHODIST MEDICAL CENTER (Active) - information as of 4/25/2025 8:31:03 PM

Main Details

Name

IOWA METHODIST MEDICAL CENTER

Subdivision Name

Iowa Lutheran Hospital - Mammography -Luth - 1022700

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH160082AJ

Medicare Provider Number

160082

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/8/2019

Participating Start Date

10/1/2019

Participating Approval Date

7/31/2019

Last Recertification Date

8/23/2024

Contacts

Authorizing Official

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

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 50316-2392

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?
Yes

State	Medicaid Number	NPI Number
IA	0600825,0600247	1356433049

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
DSH160082A	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION /Maternity Unit -West - 3015000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082AA	Child	DSH	IOWA METHODIST MEDICAL CENTER	Infusion Center - Infusion Center - Meth - 2024000	1221 Pleasant Street	Des Moines	IA	Active
DSH160082AB	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Recovery - Ambulatory Surgery - 1020100	700 East University Avenue	Des Moines	IA	Active
DSH160082AC	Child	DSH	IOWA METHODIST MEDICAL CENTER	Blank Children's Infusion Center - BIC - 2024010	1215 Pleasant Street	Des Moines	IA	Active
DSH160082AD	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Psychiatric Services - 1012300	700 East University Avenue	Des Moines	IA	Terminated
DSH160082AE	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Cardiac Rehabilitation - 1034200	700 East University Avenue	Des Moines	IA	Active
DSH160082AF	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Renal Dialysis - 1026100	700 East University Avenue	Des Moines	IA	Active
DSH160082AG	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Access Center - ED - 1031600	700 East University Avenue	Des Moines	IA	Active
DSH160082AH	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Vascular Lab - 1022600	700 East University Avenue	Des Moines	IA	Active
DSH160082AJ	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Mammography -Luth - 1022700	700 East University Avenue	Des Moines	IA	Active
DSH160082AK	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Nuclear Medicine - Luth - 1022400	700 East University Avenue	Des Moines	IA	Active
DSH160082AL	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Outpt Pediatric MH - Luth - 1031200	700 East University Avenue	Des Moines	IA	Active
DSH160082AM	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Ambulatory Surgery - 1020120	700 East University Avenue	Des Moines	IA	Terminated
DSH160082AN	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - CT Scan - 1022100	700 East University Avenue	Des Moines	IA	Active
DSH160082AP	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Respiratory Care - LUTH - 1035000	700 East University Avenue	Des Moines	IA	Active
DSH160082AQ	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - ILH Therapy OP - 1028310	700 East University Avenue	Des Moines	IA	Active
DSH160082AR	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Echocardiography - Luth - 1034010	700 East University Avenue	Des Moines	IA	Active
DSH160082AS	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital -Surgery - LUTH - 1020000	700 East University Avenue	Des Moines	IA	Active
DSH160082AT	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Radiology - 1022200	700 East University Avenue	Des Moines	IA	Active
DSH160082AU	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Emergency Department - Luth - 1033000	700 East University Avenue	Des Moines	IA	Active
DSH160082AV	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Cardiac Cath Lab - 1034100	700 East University Avenue	Des Moines	IA	Active
DSH160082AW	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Infusion Center- Luth - 1024000	700 East University Avenue	Des Moines	IA	Active
DSH160082AX	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Adult Partial Hospitalization - 1031430	700 East University Avenue	Des Moines	IA	Active
DSH160082AY	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - ILH Therapy - 1028300	700 East University Avenue	Des Moines	IA	Active
DSH160082AZ	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Endoscopy - Luth - 1020400	700 East University Avenue	Des Moines	IA	Active
DSH160082B	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Emergency 3033000	1660 60TH Street	WEST DES MOINES	IA	Active
DSH160082BA	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - MRI - Luth - 1022300	700 East University Avenue	Des Moines	IA	Active
DSH160082BB	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Recovery Room PACU LUTH - 1020200	700 East University Avenue	Des Moines	IA	Active
DSH160082BC	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - EKG-LUTH - 1034000	700 East University Avenue	Des Moines	IA	Active
DSH160082BD	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Electroencephalography - 1032000	700 East University Avenue	Des Moines	IA	Active
DSH160082BE	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - ECT - 1031710	700 East University Avenue	Des Moines	IA	Active
DSH160082BF	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Powell CDC - 1031000	700 East University Avenue	Des Moines	IA	Active
DSH160082BG	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - Blank Pediatric Gastroenterology 2043400	1215 PLEASANT STREET	DES MOINES	IA	Active
DSH160082BH	Child	DSH	IOWA METHODIST MEDICAL CENTER	UNITYPOINT HEALTH - DES MOINES BLAN - Blank Pediatric Pulmonology 2043100	1212 PLEASANT STREET	DES MOINES	IA	Active
DSH160082BJ	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - Blank Pediatric Endocrinology - 2043600	1215 Pleasant Street	Des Moines	IA	Active
DSH160082BK	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology - Lakeview 2043010	6000 UNIVERSITY AVENUE	WEST DES MOINES	IA	Active
DSH160082BL	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology and Cardiac Arrythmia - Plaza 2043000	1215 PLEASANT STREET	DES MOINES	IA	Active
DSH160082BM	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines Infectious Disease - Plaza 2043900	1221 PLEASANT STREET	DES MOINES	IA	Active
DSH160082BN	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Neurology - Plaza 2043200	1221 PLEASANT ST STE 300	DES MOINES	IA	Active
DSH160082BP	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Cardiology - Penn Ave 1043000	1301 PENNSYLVANIA AVENUE	DES MOINES	IA	Active
DSH160082BQ	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines - Neurology - Lakeview 2043200	6000 UNIVERSITY AVENUE	WEST DES MOINES	IA	Active
DSH160082BR	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Pediatrics - 2041500	1212 PLEASANT ST STE 300	DES MOINES	IA	Active
DSH160082BS	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORP - UnityPoint Health - Des Moines Blank Children's Psychiatry - 2044700	1206 PLEASANT ST	DES MOINES	IA	Active
DSH160082BT	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Diagnostics - 2043920	1212 PLEASANT ST STE 300	DES MOINES	IA	Active
DSH160082BU	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Palliative Care - 2038320	1212 PLEASANT ST STE 300	DES MOINES	IA	Active
DSH160082BV	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health - Des Moines Blank Children's Orthopaedics - 2042410	1215 PLEASANT STREET	DES MOINES	IA	Active
DSH160082BW	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - UnityPoint Health Des Moines Blank Children's Neurology 2043210	1215 PLEASANT ST STE 303	DES MOINES	IA	Active
DSH160082BX	Child	DSH	IOWA METHODIST MEDICAL CENTER	Central Iowa Hospital Corporation - UnityPoint Health - Des Moines Medication Therapy Management - 2023300	1212 Pleasant Street	Des Moines	IA	Active
DSH160082BY	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - Counseling and Psychiatry - Lakeview 3044500	6000 UNIVERSITY AVE STE 200	WEST DES MOINES	IA	Active
DSH160082BZ	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION - Behavioral Health Urgent Care - 1044620	1250 E 9TH ST	DES MOINES	IA	Active
DSH160082C	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION /Surgery-West 3020000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082CA	Child	DSH	IOWA METHODIST MEDICAL CENTER	UNITYPOINT HEALTH - DES MOINES BLAN - Children's Treatment/Surgery Room - 2020920	1206 PLEASANT ST	DES MOINES	IA	Active
DSH160082D	Child	DSH	IOWA METHODIST MEDICAL CENTER	IOWA METHODIST HAND CLINIC	6001 WESTOWN PKWY #101	WEST DES MOINES	IA	Terminated
DSH160082E	Child	DSH	IOWA METHODIST MEDICAL CENTER	JOHN STODDARD CANCER CENTER - 2027030	1221 PLEASANT STREET	DES MOINES	IA	Active
DSH160082F	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Eye Surgery Center - 2020110	1300 37TH STREET	WEST DES MOINES	IA	Active
DSH160082G	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Wound Healing Center	1215 PLEASANT ST	DES MOINES	IA	Terminated
DSH160082H	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / EEG-West - 3032000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082J	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Echocardiography - West 3034010	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082K	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Therapy Services MWH - West 3028300	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082L	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / EKG-West 3034000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082M	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION /Respiratory Care-West 3035000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082N	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Blood Bank	1660 60TH ST	WEST DES MOINES	IA	Terminated
DSH160082P	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Methodist West Hospital - Laboratory	1660 60TH ST	WEST DES MOINES	IA	Terminated
DSH160082Q	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / MRI - West 3022300	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082R	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / CT SCAN -WEST 3022100	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082S	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Ultrasound - West 3022500	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082T	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Nuclear Medicine West - 3022400	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082U	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION /General Radiology - West 3022200	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082V	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / PACU - West - 3020200	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082W	Child	DSH	IOWA METHODIST MEDICAL CENTER	CENTRAL IOWA HOSPITAL CORPORATION / Surgery -West 3020000	1660 60TH STREET	WEST DES MOINES	IA	Active
DSH160082X	Child	DSH	IOWA METHODIST MEDICAL CENTER	Central Iowa Hospital Corporation/ Orthopedics 3-West 3010610	1660 60th Street	West Des Moines	IA	Active
DSH160082Y	Child	DSH	IOWA METHODIST MEDICAL CENTER	Central Iowa Hospital Corporation/ Med/Surg 4- West 3010710	1660 60th Street	West Des Moines	IA	Active
DSH160082Z	Child	DSH	IOWA METHODIST MEDICAL CENTER	Iowa Lutheran Hospital - Ultrasound - Luth- 1022500	700 East University Avenue	Des Moines	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Jaeger, Paige L Vice President, Operations UnityPoint Health Des Moines 5152414422	Rozenfeld, Jon Market President UnityPoint Health - Des Moines 5152416396	3/25/2025 7:28 AM
Contacts	Authorizing Official	Update	Change Request	Mulrooney, Thomas P Chief Operating Officer UnityPoint Health 5152414027	Jaeger, Paige L Vice President, Operations UnityPoint Health Des Moines 5152414422	1/2/2025 3:36 PM
Details	Last Recertification Date	Update	Recertification	8/14/2023 11:36:46 AM	8/23/2024 7:12:18 AM	8/23/2024 7:12 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 1:17:44 PM	8/14/2023 11:36:46 AM	8/14/2023 11:36 AM
Contacts	Authorizing Official	Update	Change Request	Lothe, Eric SVP/COO UnityPoint Des Moines 5152415858	Mulrooney, Thomas P Chief Operating Officer UnityPoint Health 5152414027	12/13/2022 11:19 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 9:58:52 AM	8/29/2022 1:17:44 PM	8/29/2022 1:17 PM
Details	Entity Subname	Update	Recertification	Iowa Lutheran Hospital - Mammography - 1022700	Iowa Lutheran Hospital - Mammography -Luth - 1022700	8/29/2022 1:17 PM
Details	Last Recertification Date	Update	Recertification	8/21/2020 10:04:20 AM	8/23/2021 9:58:52 AM	8/23/2021 9:58 AM
Medicaid Billing	NPI: State	Update	Recertification		IA	8/21/2020 10:04 AM
Details	Last Recertification Date	Update	Recertification		8/21/2020 10:04:20 AM	8/21/2020 10:04 AM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Contacts	Signed By	Insert	New Registration		Lothe, Eric SVP/COO UnityPoint Des Moines 5152415858	7/31/2019 2:11 PM
Details	340B ID	Update	New Registration		DSH160082AJ	7/31/2019 2:11 PM
Details	Entity Subname	Update	New Registration	Iowa Lutheran Hospital	Iowa Lutheran Hospital - Mammography - 1022700	7/31/2019 2:11 PM
Dates	Participating Approval Date	Update	New Registration		7/31/2019 2:11:35 PM	7/31/2019 2:11 PM
Details	State	Update	New Registration	Pending	Approved	7/31/2019 2:11 PM
Dates	Signed By Date	Update	New Registration		7/9/2019 11:51:48 AM	7/31/2019 2:11 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	7/31/2019 2:11 PM
Addresses	Main Address	Insert	New Registration		700 East University Avenue Des Moines, IA 50316-2392	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600825	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600247	7/8/2019 10:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	7/8/2019 10:52 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1356433049	7/8/2019 10:52 AM
Contacts	Authorizing Official	Insert	New Registration		Lothe, Eric SVP/COO UnityPoint Des Moines 5152415858	7/8/2019 10:52 AM
Contacts	Primary Contact	Insert	New Registration		Benson, Brian D. Executive Director of Pharmacy UnityPoint Health Des Moines 5152413411	7/8/2019 10:52 AM
Details	Last Recertification Date	Insert	New Registration			7/8/2019 10:52 AM
Details	Grant Number	Insert	New Registration			7/8/2019 10:52 AM
Details	340B ID	Insert	New Registration			7/8/2019 10:52 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/8/2019 10:52 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/8/2019 10:52 AM
Details	Medicare Provider Number	Insert	New Registration		160082	7/8/2019 10:52 AM
Details	Entity Name	Insert	New Registration		IOWA METHODIST MEDICAL CENTER	7/8/2019 10:52 AM
Details	Program Code	Insert	New Registration		DSH	7/8/2019 10:52 AM
Details	Entity Subname	Insert	New Registration		Iowa Lutheran Hospital	7/8/2019 10:52 AM
Dates	Participating Approval Date	Insert	New Registration			7/8/2019 10:52 AM
Details	State	Insert	New Registration		Pending	7/8/2019 10:52 AM
Dates	Registration Date	Insert	New Registration		7/8/2019 10:52:46 AM	7/8/2019 10:52 AM
Dates	Signed By Date	Insert	New Registration			7/8/2019 10:52 AM
Dates	Start Date	Insert	New Registration			7/8/2019 10:52 AM
Terminations	Termination Comments	Insert	New Registration			7/8/2019 10:52 AM
Terminations	Termination Date	Insert	New Registration			7/8/2019 10:52 AM
Terminations	Termination Effective Date	Insert	New Registration			7/8/2019 10:52 AM
Terminations	Termination Reason	Insert	New Registration			7/8/2019 10:52 AM