340B Drug Pricing Program Database
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The Q2 2025 registration window for covered entities is open from 4/1/2025 - 4/15/2025.
DSH160067CM MercyOne Waterloo Medical Center (Active)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
MercyOne Oelwein Urgent Care & Occupational Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067CM
Medicare Provider Number
160067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/1/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/3/2019
Last Recertification Date
9/2/2024
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
Covenant Medical Center
Jaclyn Annette Van Raden, 340B Contract Pharmacy Analyst
(319) 272-8636
Addresses
Street Address
129 8th Avenue SE
OELWEIN, IA 50662-2447
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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