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DSH160033AP GENESIS MEDICAL CENTER - DAVENPORT (Active)
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Main Details
Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
Cardiac Diagnostics - Cardiac Diagnostics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160033AP
Medicare Provider Number
160033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/27/2020
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
MercyOne Genesis Davenport
Christopher Michael Crome, Chief Operating Officer
(563) 421-6502
Primary Contact
Genesis Health System
Adam Baird, Director of Pharmacy
(563) 421-6212
Addresses
Street Address
1236 E Rusholme
Heart Institute
2nd Floor
Davenport, IA 52803
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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