Covered Entity Details

DSH160083AF CATHOLIC HEALTH INITIATIVES - IOWA, CORP (Terminated) - information as of 5/27/2025 11:38:00 PM

Main Details

Name

CATHOLIC HEALTH INITIATIVES - IOWA, CORP

Subdivision Name

MERCYONE DES MOINES INTERNAL MED - Internal Medicine

Type

Disproportionate Share Hospital

Rural

340B ID

DSH160083AF

Medicare Provider Number

160083

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

5/27/2021

Participating Start Date

6/8/2021

Participating Approval Date

6/8/2021

Last Recertification Date

9/7/2022

Termination Date
Termination Reason

4/1/2023
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

Catholic Health Initiatives, Iowa Corp.
Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860

Primary Contact

Catholic Health Initiatives, Iowa Corp
Kevin McVey, interim PIC
(515) 643-2934

Addresses

Street Address

411 LAUREL ST
STE 2310
DES MOINES, IA 50314-3005

Billing Address

Catholic Health Initiatives
PO Box 636000
Littleton, CO 80163-6000

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	0600002,0600833	1538395975,1508964883
MO	011266400	1508964883

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
DSH160083A	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CENTER	1755 59th Place	WEST DES MOINES	IA	Terminated
DSH160083AA	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	Mercy North Surgery Clinic	800 E. First Street	Ankeny	IA	Terminated
DSH160083AB	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne Ankeny Endoscopy	800 E 1st St	Ankeny	IA	Active
DSH160083AC	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (4th Floor ICU)	1755 59th Place	West Des Moines	IA	Active
DSH160083AD	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (5th Floor Med/Surg)	1755 59th Place	West Des Moines	IA	Active
DSH160083AE	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (4th Floor Med/Surg)	1755 59th Place	West Des Moines	IA	Active
DSH160083AF	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES INTERNAL MED - Internal Medicine	411 LAUREL ST	DES MOINES	IA	Terminated
DSH160083AG	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES DIABETES AND EN - Diabetes and Endocrinology Care	411 LAUREL ST SUITE 3262	DES MOINES	IA	Active
DSH160083AH	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES NEUROPSYCHOLOGY - Neuropsychology	1111 6TH AVE EAST TOWER STE B1	DES MOINES	IA	Active
DSH160083AJ	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES NEUROSURGERY - Neurosurgery	1111 6TH AVE EAST TOWER STE B1	DES MOINES	IA	Active
DSH160083AK	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES SURGICAL GROUP - Surgical Group	411 LAUREL ST SUITE 2100	DES MOINES	IA	Active
DSH160083AL	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES PULMONARY INFEC - Pulmonary and Infectious Disease Care	411 LAUREL ST	DES MOINES	IA	Active
DSH160083AM	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH IOWA CORP - Iowa Heart Center (IH Heart Failure-Laurel)	411 LAUREL ST STE 1225	DES MOINES	IA	Active
DSH160083AN	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - Iowa Heart Center (IH Heart Failure-West University)	5880 UNIVERSITY AVE SUITE 102	WEST DES MOINES	IA	Active
DSH160083AP	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne Iowa Heart Center Des Moines (IH-SV Surg-Laurel) - Iowa Heart Center (IH-SV Surg-Laurel)	411 Laurel St STE A250	Des Moines	IA	Active
DSH160083AQ	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - Iowa Heart Center (IH-Arry Srvcs-West Univeristy)	5880 UNIVERSITY AVE SUITE 112	WEST DES MOINES	IA	Active
DSH160083AR	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH IOWA CORP - Iowa Heart Center (IH-Cardiac Rehab-Laurel)	411 LAUREL ST STE A250	DES MOINES	IA	Active
DSH160083AS	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - Iowa Heart Center (IH-Clinic Srvs-West University)	5880 UNIVERSITY AVE SUITE 102	WEST DES MOINES	IA	Active
DSH160083AT	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH IOWA CORP - Iowa Heart Center (IH-IV Structural-Laurel)	411 LAUREL ST STE A250	DES MOINES	IA	Active
DSH160083AU	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH IOWA CORP - Iowa Heart Center (IH-Clinic Srvs-Laurel)	411 LAUREL ST STE A250	DES MOINES	IA	Active
DSH160083AV	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - Iowa Heart Center (IH-PV Surg-West University)	5880 UNIVERSITY AVE SUITE 103	WEST DES MOINES	IA	Active
DSH160083AW	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH IOWA CORP - Iowa Heart Center (IH-Arry Srvcs-Laurel)	411 LAUREL ST STE A250	DES MOINES	IA	Active
DSH160083AX	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - Iowa Heart Center (IH-Vein Ctr-West University)	5880 UNIVERSITY AVE SUITE 103	WEST DES MOINES	IA	Active
DSH160083AY	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CE - MWL Radiology-Diagnostic	1755 59TH PL	WEST DES MOINES	IA	Active
DSH160083AZ	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CE - MWL Cardiac Rehab	1755 59TH PL	WEST DES MOINES	IA	Active
DSH160083BA	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CE - MWL Bariatric Program	1755 59TH PL	WEST DES MOINES	IA	Active
DSH160083BB	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CE - MercyOne West Des Moines Birthing Center	1755 59TH PL	WEST DES MOINES	IA	Active
DSH160083BC	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE WEST DES MOINES MEDICAL CE - MercyOne West Des Moines Labor and Birthing Center	1755 59TH PL	WEST DES MOINES	IA	Active
DSH160083BD	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	CATHOLIC HEALTH INITIATIVES-IOWA CO - IH-Prevention and Wellness Clinic	5880 UNIVERSITY AVE SUITE 102	WEST DES MOINES	IA	Active
DSH160083BE	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	Mercyone Des Moines Cancer & Infusion Care - Newton - Infusion Center	204 N 4th Ave E	Newton	IA	Active
DSH160083C	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne Des Moines Cancer Care	411 LAUREL ST	DES MOINES	IA	Active
DSH160083D	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne Des Moines Ambulatory Surgery	411 LAUREL ST	DES MOINES	IA	Active
DSH160083E	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE CLIVE SLEEP CENTER	1449 NW 128th ST	CLIVE	IA	Active
DSH160083G	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES FIRST STEP RECOVERY	1750 48TH ST	DES MOINES	IA	Terminated
DSH160083H	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCY WEST RADIOLOGY	1601 NW 114TH ST	CLIVE	IA	Terminated
DSH160083J	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE DES MOINES CARDIAC & PULMONARY PREVENTION AND REHABILITATION	411 Laurel St	DES MOINES	IA	Active
DSH160083L	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne Des Moines Outpatient Cardiac Testing	411 Laurel St	DES MOINES	IA	Active
DSH160083M	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Outpatient Cardiac Testing	5880 UNIVERSITY AVE	WEST DES MOINES	IA	Active
DSH160083Q	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCY RADIOLOGY CENTER	12495 UNIVERSITY AVE	CLIVE	IA	Terminated
DSH160083R	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE RIVERSIDE REHABILITATION	501 SW 7th St.	DES MOINES	IA	Active
DSH160083T	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCY ATRIUM IMAGING SUITE	411 LAUREL ST.	DES MOINES	IA	Terminated
DSH160083U	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MERCYONE CLIVE ENDOSCOPY	1601 NW 114TH ST	CLIVE	IA	Active
DSH160083V	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (Emergency Room)	1755 59th Place	West Des Moines	IA	Active
DSH160083W	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (Cath Lab)	1755 59th Place	West Des Moines	IA	Active
DSH160083X	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (3rd Floor Med Surg)	1755 59th Place	West Des Moines	IA	Active
DSH160083Y	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (Surgery)	1755 59th Place	West Des Moines	IA	Active
DSH160083Z	Child	DSH	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	MercyOne West Des Moines Medical Center (Recovery Room-PACU)	1755 59th Place	West Des Moines	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2023 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/30/2023 12:00:00 AM	2/14/2023 3:43 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/14/2023 3:43 PM
Terminations	Termination Comments	Update	Termination Request		Internal medicine site is moving and will no longer be provider based billing or 340B eligible.	2/14/2023 3:43 PM
Terminations	Termination Date	Update	Termination Request		4/1/2023 12:00:00 AM	2/14/2023 3:43 PM
Terminations	Termination Effective Date	Update	Termination Request		1/30/2023 12:00:00 AM	2/14/2023 3:43 PM
Terminations	Termination Reason	Update	Termination Request		Hospital Outpatient facility no longer eligible	2/14/2023 3:43 PM
Contacts	Primary Contact	Update	Recertification	Jordan, Candace Marie Mkt Director of Pharmacy Catholic Health Initiatives, Iowa Corp 5152473262	McVey, Kevin interim PIC Catholic Health Initiatives, Iowa Corp 5156432934	9/7/2022 8:10 PM
Details	Last Recertification Date	Update	Recertification	8/27/2021 9:44:49 AM	9/7/2022 8:10:39 PM	9/7/2022 8:10 PM
Details	Last Recertification Date	Update	Recertification		8/27/2021 9:44:49 AM	8/27/2021 9:44 AM
Details	State	Update	OPA Edit	Approved	Active	6/8/2021 9:14 AM
Dates	Start Date	Update	OPA Edit	7/1/2021 12:00:00 AM	6/8/2021 12:00:00 AM	6/8/2021 9:14 AM
Contacts	Signed By	Insert	New Registration		Rubin, Randall Senior Vice President Chief Financial Officer Catholic Health Initiatives, Iowa Corp. 5156432860	6/8/2021 8:57 AM
Details	340B ID	Update	New Registration		DSH160083AF	6/8/2021 8:57 AM
Details	Entity Name	Update	New Registration	MERCY MEDICAL CENTER-DES MOINES	CATHOLIC HEALTH INITIATIVES - IOWA, CORP	6/8/2021 8:57 AM
Details	Entity Subname	Update	New Registration	MERCYONE DES MOINES INTERNAL MED	MERCYONE DES MOINES INTERNAL MED - Internal Medicine	6/8/2021 8:57 AM
Dates	Participating Approval Date	Update	New Registration		6/8/2021 8:57:07 AM	6/8/2021 8:57 AM
Details	State	Update	New Registration	Pending	Approved	6/8/2021 8:57 AM
Dates	Signed By Date	Update	New Registration		5/28/2021 10:20:32 AM	6/8/2021 8:57 AM
Dates	Start Date	Update	New Registration		7/1/2021 12:00:00 AM	6/8/2021 8:57 AM
Addresses	Main Address	Insert	New Registration		411 LAUREL ST STE 2310 DES MOINES, IA 50314-3005	5/27/2021 4:43 PM
Addresses	Billing Address	Insert	New Registration		Catholic Health Initiatives PO Box 636000 Littleton, CO 80163-6000	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600002	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0600833	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		011266400	5/27/2021 4:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MO	5/27/2021 4:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538395975	5/27/2021 4:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	5/27/2021 4:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508964883	5/27/2021 4:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		IA	5/27/2021 4:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508964883	5/27/2021 4:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		MO	5/27/2021 4:43 PM
Contacts	Authorizing Official	Insert	New Registration		Rubin, Randall Senior Vice President Chief Financial Officer Catholic Health Initiatives, Iowa Corp. 5156432860	5/27/2021 4:43 PM
Contacts	Primary Contact	Insert	New Registration		Jordan, Candace Marie Mkt Director of Pharmacy Catholic Health Initiatives, Iowa Corp 5152473262	5/27/2021 4:43 PM
Details	Assistance Received From Date	Insert	New Registration			5/27/2021 4:43 PM
Details	Assistance Received To Date	Insert	New Registration			5/27/2021 4:43 PM
Details	Last Recertification Date	Insert	New Registration			5/27/2021 4:43 PM
Details	Grant Number	Insert	New Registration			5/27/2021 4:43 PM
Details	340B ID	Insert	New Registration			5/27/2021 4:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			5/27/2021 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			5/27/2021 4:43 PM
Details	Medicare Provider Number	Insert	New Registration		160083	5/27/2021 4:43 PM
Details	Entity Name	Insert	New Registration		MERCY MEDICAL CENTER-DES MOINES	5/27/2021 4:43 PM
Details	NOFO Number	Insert	New Registration			5/27/2021 4:43 PM
Details	Program Code	Insert	New Registration		DSH	5/27/2021 4:43 PM
Details	Entity Subname	Insert	New Registration		MERCYONE DES MOINES INTERNAL MED	5/27/2021 4:43 PM
Dates	Participating Approval Date	Insert	New Registration			5/27/2021 4:43 PM
Details	State	Insert	New Registration		Pending	5/27/2021 4:43 PM
Dates	Registration Date	Insert	New Registration		5/27/2021 4:43:36 PM	5/27/2021 4:43 PM
Dates	Signed By Date	Insert	New Registration			5/27/2021 4:43 PM
Dates	Start Date	Insert	New Registration			5/27/2021 4:43 PM
Terminations	Termination Comments	Insert	New Registration			5/27/2021 4:43 PM
Terminations	Termination Date	Insert	New Registration			5/27/2021 4:43 PM
Terminations	Termination Effective Date	Insert	New Registration			5/27/2021 4:43 PM
Terminations	Termination Reason	Insert	New Registration			5/27/2021 4:43 PM