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CAH161361-03 Hamilton County Public Hospital d/b/a Van Diest Medical Center (Active)
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Main Details
Name
Hamilton County Public Hospital d/b/a Van Diest Medical Center
Subdivision Name
HAMILTON COUNTY PUBLIC HOSPITAL - primary care
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161361-03
Medicare Provider Number
161361
Outpatient Facility Provider Number
168652
Additional Details
Current Program Status
Active
Registration Date
8/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/23/2021
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Hamilton County Public Hospital
Ashley Nicole Allers, CFO
(515) 832-7705
Primary Contact
Van Diest Medical Center
Jordan Wagner, Director of Pharmacy
(515) 832-7744
Addresses
Street Address
119 AVENUE O W
FORT DODGE, IA 50501-5634
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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