340B Drug Pricing Program Database
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DSH160064AJ MercyOne North Iowa Medical Center (Terminated)
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Main Details
Name
MercyOne North Iowa Medical Center
Subdivision Name
MERCYONE NORTH IOWA PLASTICS & RECO - PLASTICS & RECONSTRUCTIVE SURGERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160064AJ
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2021
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 DR
SUITE 103
MASON CITY, IA 50401
Billing Address
MERCYONE NORTH IOWA MEDICAL CENTER
1000 4TH STREET SW
MASON CITY, IA 50401
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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