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DSH160033E GENESIS MEDICAL CENTER - DAVENPORT (Terminated)
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Main Details
Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
Occupational Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160033E
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
10/1/2022
Site closure
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
1401 W Central Park Ave
Davenport, IA 52804
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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