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DSH160064D MERCY MEDICAL CENTER - NORTH IOWA (Terminated)
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Main Details
Name
MERCY MEDICAL CENTER - NORTH IOWA
Subdivision Name
Mercy Dialysis Center - Charles City
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160064D
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2016
Participating Start Date
1/1/2017
Participating Approval Date
11/3/2016
Last Recertification Date
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
DANETTE ZOOK, RHM VP Finance
(641) 428-7989
Primary Contact
Mercy Medical Center - North Iowa
Craig Osland, Director of Pharmacy
(641) 428-7605
Addresses
Street Address
707 Gilbert Street
Mason City, IA 50401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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