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DSH160083H CATHOLIC HEALTH INITIATIVES - IOWA, CORP (Terminated)
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Main Details
Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCY WEST RADIOLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160083H
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
8/17/2016
Termination Date
Termination Reason
1/1/2017
Site closure
Contacts
Authorizing Official
Catholic Health Initiatives, Iowa Corp.
Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860
Primary Contact
Catholice Health Initiatives, Iowa Corp.
Gregory A. Young, DIRECTOR OF PHARMACY
(515) 247-3262
Addresses
Street Address
1601 NW 114TH ST
STE 149
CLIVE, IA 50325
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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