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DSH160080B MERCY MEDICAL CENTER-CLINTON INC D/B/A MercyOne Clinton Medical Center (Active)
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Main Details
Name
MERCY MEDICAL CENTER-CLINTON INC D/B/A MercyOne Clinton Medical Center
Subdivision Name
MERCYONE CLINTON WOUND CARE - Wound Care Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160080B
Medicare Provider Number
160080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/27/2021
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
MercyOne Clinton Medical Center
Mellissa Wood, COO/CNE
(563) 244-5608
Primary Contact
MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024
Addresses
Street Address
600 14th Ave N
CLINTON, IA 52732-4742
Billing Address
MercyOne Clinton Medical Center
1410 N 4th Street
Clinton, IA 52732
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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