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DSH160067BE COVENANT MEDICAL CENTER (Terminated)
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Main Details
Name
COVENANT MEDICAL CENTER
Subdivision Name
COVENANT Clinic Convenient Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067BE
Medicare Provider Number
160067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/7/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/19/2016
Last Recertification Date
9/2/2018
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
MercyOne Northeast Iowa
Trish Means Neuroth, Reimbursement Accountant
(319) 272-7601
Addresses
Street Address
6301 UNIVERSITY AVE STE A3
CONVENIENT CARE EXPRESS
CEDAR FALLS, IA 50613-5200
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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