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SCH160064-08 MERCYONE NORTH IOWA MEDICAL CENTER (Active)
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Main Details
Name
MERCYONE NORTH IOWA MEDICAL CENTER
Subdivision Name
MercyOne Regency Family Medicine
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH160064-08
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/6/2025
Participating Start Date
4/1/2025
Participating Approval Date
3/7/2025
Last Recertification Date
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
Ben Kofoot, VP Operations
(641) 428-7193
Primary Contact
MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024
Addresses
Street Address
621 South Illinois Avenue
Suite 100
Mason City, IA 50401-5489
Billing Address
MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2018, terminated 10/1/2019. Reinstated 4/1/2025.
01/31/2025
Initial start date as SCH 7/1/2011, termination as DSH 10/1/2018, reinstate as SCH 10/1/2018
09/05/2018
May 2025
May 2025
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