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DSH160110C Allen Memorial Hospital Corporation (Terminated)
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Main Details
Name
Allen Memorial Hospital Corporation
Subdivision Name
Allen Hospital Digestive Health Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160110C
Medicare Provider Number
160110
Outpatient Facility Provider Number
160110
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/5/2013
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
4/1/2020
Site closure
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
125 East Tower Park
Waterloo, IA 50701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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