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DSH160110F Allen Memorial Hospital Corporation (Terminated)
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Main Details
Name
Allen Memorial Hospital Corporation
Subdivision Name
Allen Memorial Hospital Community Cancer Center - Oncology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160110F
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
7/30/2019
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Other
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
1753 W Ridgeway
102
Waterloo, IA 50701
Billing Address
Allen Memorial Hospital
1825 Logan Ave
Waterloo, IA 50703
Comments
Medicaid Billing
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Contract Pharmacies
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