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DSH160083G CATHOLIC HEALTH INITIATIVES - IOWA, CORP (Terminated)
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Main Details
Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES FIRST STEP RECOVERY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160083G
Medicare Provider Number
160083
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/3/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/15/2011
Last Recertification Date
8/27/2021
Termination Date
Termination Reason
7/1/2022
Site closure
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
Candace Marie Jordan, Mkt Director of Pharmacy
(515) 247-3262
Addresses
Street Address
1750 48TH ST
STE 2
DES MOINES, IA 50310-1988
Billing Address
CATHOLIC HEALTH INITIATIVES - IOWA, CORP DBA MERCY MEDICAL CENTER
PO BOX 14584
DES MOINES, IA 50306-3584
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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