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SCH160001-00 UNITYPOINT HEALTH-MARSHALLTOWN (Terminated)
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Main Details
Name
UNITYPOINT HEALTH-MARSHALLTOWN
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH160001-00
Medicare Provider Number
160001
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/26/2018
Last Recertification Date
9/3/2021
Termination Date
Termination Reason
1/1/2022
DSH percentage below statutory minimum
Contacts
Authorizing Official
Allen Memorial Hospital
Pamela K. Delagardelle, President/CEO
(319) 235-3606
Primary Contact
Allen Memorial Hospital Corporation
Dave B Phillips, Director Compliance
(319) 369-7121
Addresses
Street Address
3 SOUTH 4TH AVENUE
MARSHALLTOWN, IA 50158
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (1/1/2014) until terminated effective date (7/1/2016), reinstatement effective date (01/'01/2019)
10/26/2018
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