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DSH160058AL UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER (ToBeTerminated)
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Main Details
Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
UNIVERSITY OF IOWA HEALTH CARE- IRL EAST - RADIOLOGY DIAGNOSTIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160058AL
Medicare Provider Number
160058
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
1/15/2019
Participating Start Date
4/1/2019
Participating Approval Date
3/7/2019
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
7/1/2025
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
920 E 2ND AVE
CORALVILLE, IA 52241
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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