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DSH160058AK UNIVERSITY OF IOWA HOSPITALS & CLINICS (Terminated)
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Main Details
Name
UNIVERSITY OF IOWA HOSPITALS & CLINICS
Subdivision Name
UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL - PHYSICAL THERAPY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160058AK
Medicare Provider Number
160058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/24/2023
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
4/1/2024
Site closure
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
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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Participated starting 4/1/2019, terminated 10/1/2021. Reinstated 4/1/2023.
01/23/2023
May 2025
May 2025
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