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DSH160057AC Southeast Iowa Regional Medical Center (Active)
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Main Details
Name
Southeast Iowa Regional Medical Center
Subdivision Name
WOUND CARE-SOUTHEAST IOWA REGIONAL - Wound Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160057AC
Medicare Provider Number
160057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/11/2022
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Great River Health System
Jeremy Alexander, Chief Financial Officer
(319) 768-3280
Primary Contact
Southeast Iowa Regional Medical Center
Steve Frigo, Director, Pharmacy
(319) 768-3971
Addresses
Street Address
1401 W AGENCY RD
STE 172
WEST BURLINGTON, IA 52655-1659
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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