340B Drug Pricing Program Database
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DSH160083AE CATHOLIC HEALTH INITIATIVES - IOWA, CORP (Active)
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Main Details
Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MercyOne West Des Moines Medical Center (4th Floor Med/Surg)
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160083AE
Medicare Provider Number
160083
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/20/2015
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
MercyOne
Terri Jane Donovan, Interim Chief Financial Officer
(515) 643-8212
Primary Contact
MercyOne
Jennifer Lynn Egbert, Market Director of Pharmacy
(304) 730-5888
Addresses
Street Address
1755 59th Place
West Des Moines, IA 50266
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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