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DSH160110E Allen Memorial Hospital Corporation (Terminated)
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Main Details
Name
Allen Memorial Hospital Corporation
Subdivision Name
UNITY POINT HEALTH WATERLOO CENTER FOR UROLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160110E
Medicare Provider Number
160110
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/20/2019
Last Recertification Date
9/13/2019
Termination Date
Termination Reason
4/1/2020
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Allen Memorial Hospital
Pamela K. Delagardelle, President/CEO
(319) 235-3606
Primary Contact
Allen Memorial Hospital Corporation
Dave B Phillips, Director Compliance
(319) 369-7121
Addresses
Street Address
1717 W RIDGEWAY AVE
WATERLOO, IA 50701-4543
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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