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DSH160033R GENESIS MEDICAL CENTER - DAVENPORT (Terminated)
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Main Details
Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
Physical Therapy Clinic / LeClaire
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160033R
Medicare Provider Number
160033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/1/2018
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Genesis Health System
Jordan Voigt, GMC Davenport President
(563) 421-2792
Primary Contact
Genesis Health System
Kevin Cassatt, Director of Pharmacy
(563) 421-6212
Addresses
Street Address
1003 Canal Shore Drive
LeClaire, IA 52753
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2017, terminated 1/1/2018. Reinstated 1/1/2019.
10/30/2018
April 2025
April 2025
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