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CAH161300-01 BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER (Terminated)
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Main Details
Name
BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER
Subdivision Name
RURAL HEALTH CLINIC IV
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161300-01
Medicare Provider Number
161300
Outpatient Facility Provider Number
163492
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/19/2017
Last Recertification Date
8/14/2023
Termination Date
Termination Reason
4/1/2024
Site closure
Contacts
Authorizing Official
MercyOne
Jesica Hanson, VP of Finance
(712) 279-5850
Primary Contact
MercyOne
Brett Bieber, Director of Pharmacy
(712) 279-5992
Addresses
Street Address
231 N EIGHTH AVE W
HARTLEY, IA 51346-1077
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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