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DSH160058W UNIVERSITY OF IOWA HOSPITALS & CLINICS (Terminated)
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Main Details
Name
UNIVERSITY OF IOWA HOSPITALS & CLINICS
Subdivision Name
STATE UNIVERSITY OF IOWA - IRL - Family Care Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160058W
Medicare Provider Number
160058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/17/2018
Last Recertification Date
9/3/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
University of Iowa Health Care
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Primary Contact
University of Iowa Health Care
Becky Marie Triplett, Manager, 340B and Compliance
(319) 384-5583
Addresses
Street Address
105 E 9TH ST
IOWA RIVER LANDING - UNIVERSITY OF IOWA HEALTHCARE
CORALVILLE, IA 52241-2209
Billing Address
University of Iowa Accounts Payable
202 PCO
Iowa City, IA 52242
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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