340B Drug Pricing Program Database
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DSH160067 MercyOne Waterloo Medical Center (Active)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067
Medicare Provider Number
160067
Additional Details
Current Program Status
Active
Registration Date
12/8/2010
Participating Start Date
1/1/2011
Participating Approval Date
12/16/2010
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
Covenant Medical Center
Jaclyn Annette Van Raden, 340B Contract Pharmacy Analyst
(319) 272-8636
Addresses
Street Address
3421 W 9TH STREET
WATERLOO, IA 50702
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/7/2010- DOC. SUBMITTED TO DEMONSTRATE ELIG. DSH PERCENTAGE;05/12/11 ADDED SHIP TO ADDR.
05/12/2011
May 2025
May 2025
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