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DSH160064U MercyOne North Iowa Medical Center (Terminated)
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Main Details
Name
MercyOne North Iowa Medical Center
Subdivision Name
MercyOne Rockford Family Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160064U
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/26/2019
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
Mark Trammel, HM VP Finance
(641) 428-7984
Primary Contact
MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024
Addresses
Street Address
702 E Main Avenue
Rockford, IA 50468-1324
Billing Address
MercyOne North Iowa Medical Center
1000 4th Street SW
Mason City, IA 50401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (1/1/2017) until terminated effective date: (10/012018), reinstatement effective date: (10/01/2019)
07/26/2019
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