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DSH160067V COVENANT MEDICAL CENTER (Terminated)
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Main Details
Name
COVENANT MEDICAL CENTER
Subdivision Name
COVENANT CLINIC ARLINGTON
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067V
Medicare Provider Number
160067
Outpatient Facility Provider Number
163438
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/17/2011
Last Recertification Date
8/12/2014
Termination Date
Termination Reason
7/1/2015
Loss of qualifying grant/support
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
Covenant Medical Center
TRISH MEANS NEUROTH, Reimbursement Supervisor
(319) 272-7601
Addresses
Street Address
751 MAIN STREET
ARLINGTON, IA 50606
Billing Address
COVENANT CLINIC
PO BOX 6200
WATERLOO, IA 50704
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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