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SCH160064-14 MERCY MEDICAL CENTER - NORTH IOWA (Terminated)
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Main Details
Name
MERCY MEDICAL CENTER - NORTH IOWA
Subdivision Name
Mercy Kidney Center
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH160064-14
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/4/2018
Participating Start Date
10/1/2018
Participating Approval Date
9/5/2018
Last Recertification Date
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
DANETTE ZOOK, RHM VP Finance
(641) 428-7989
Primary Contact
MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024
Addresses
Street Address
910 North Eisenhower Avenue
Mason City, IA 50401
Billing Address
Mercy Medical Center - North Iowa
1000 4th Street SW
Mason City, IA 50401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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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
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