340B Drug Pricing Program Database
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DSH160110G Allen Memorial Hospital Corporation (Terminated)
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Main Details
Name
Allen Memorial Hospital Corporation
Subdivision Name
Allen Memorial Hospital Infusion Center - Infusion Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160110G
Medicare Provider Number
160110
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/29/2019
Last Recertification Date
8/13/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Allen Memorial Hospital Corporation
Jennifer A Friedly, President
(319) 235-3997
Primary Contact
Allen Memorial Hospital Corporation
Natalie Arlene Hunter, VP Operations
(319) 235-3660
Addresses
Street Address
1731 W Ridgeway
600
Waterloo, IA 50701
Billing Address
Allen Memorial Hospital
1825 Logan Ave
Waterloo, IA 50703
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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