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DSH160067CF MercyOne Waterloo Medical Center (Active)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
MercyOne Traer Physical Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067CF
Medicare Provider Number
160067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/19/2016
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
Covenant Medical Center
Jaclyn Annette Van Raden, 340B Contract Pharmacy Analyst
(319) 272-8636
Addresses
Street Address
549 Second Street
Traer, IA 50675-1100
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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