340B Drug Pricing Program Database
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DSH160064AN MercyOne North Iowa Medical Center (Terminated)
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Main Details
Name
MercyOne North Iowa Medical Center
Subdivision Name
MERCYONE NORTH IOWA ALLERGY & IMMUN - Allergy & Immunology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160064AN
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/15/2021
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
1/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
MercyOne North Iowa Medical Center
Mark Trammel, HM VP Finance
(641) 428-7984
Primary Contact
MercyOne North Iowa Medical Center
Erin Brownmiller, 340B Program Manager
(641) 428-7024
Addresses
Street Address
250 S CRESCENT DRIVE
SUITE 102
MASON CITY, IA 50401
Billing Address
MERCYONE NORTH IOWA MEDICAL CENTER
1000 4th STREET SW
MASON CITY, IA 50401-2800
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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