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CAH161316-02 Palmer Lutheran Health Center (Active)
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Main Details
Name
Palmer Lutheran Health Center
Subdivision Name
Fayette RHC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161316-02
Medicare Provider Number
161316
Outpatient Facility Provider Number
168584
Additional Details
Current Program Status
Active
Registration Date
4/11/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Palmer Lutheran Health Center
Brenda Moser, Finance Administrator
(563) 422-3811 Ext: 64783
Primary Contact
Palmer Lutheran Health Center, Inc
Emily Mork, PharmD
(563) 422-3811 Ext: 64723
Addresses
Street Address
110 King Street
Fayette, IA 52142
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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