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DSH160110 Allen Memorial Hospital Corporation (Active)
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Main Details
Name
Allen Memorial Hospital Corporation
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160110
Medicare Provider Number
160110
Additional Details
Current Program Status
Active
Registration Date
1/15/2013
Participating Start Date
1/1/2014
Participating Approval Date
3/8/2013
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Allen Memorial Hospital Corporation
Jennifer A Friedly, President
(319) 235-3997
Primary Contact
Allen Memorial Hospital Corporation
Natalie Arlene Hunter, VP Operations
(319) 235-3660
Addresses
Street Address
1825 Logan Avenue
Waterloo, IA 50703-1916
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/13/13 enrolled 4/1/13 thru 9/30/13, not enrolled 10/1/13 thru 12/31/13 due to request of covered entity, re-instated based on on-line registration submitted in Oct. 2013
12/13/2013
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