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DSH160047 JENNIE EDMUNDSON MEMORIAL (Active)
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Main Details
Name
JENNIE EDMUNDSON MEMORIAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160047
Medicare Provider Number
160047
Additional Details
Current Program Status
Active
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/2/2015
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Methodist Jennie Edmundson Hospital
David Burd, President & CEO
(712) 396-6064
Primary Contact
Methodist Jennie Edmundson Hospital
Melanie L. Ryan, Pharmacy Director
(712) 396-7707
Addresses
Street Address
933 EAST PIERCE STREET
COUNCIL BLUFFS, IA 51503
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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