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CAH161367-05 PELLA REGIONAL HEALTH CENTER (Active)
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Main Details
Name
PELLA REGIONAL HEALTH CENTER
Subdivision Name
Pella Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH161367-05
Medicare Provider Number
161367
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/6/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/27/2022
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Pella Regional Health Center
Jody VanVeen, Chief Nursing and Chief Ancillary Officer
(641) 628-6629
Primary Contact
Pella Regional Health Center
Jessica Ann Rosenhamer, Pharmacy Director
(641) 628-6616
Addresses
Street Address
405 MONROE ST
PELLA REG MED CLINIC
PELLA, IA 50219-1189
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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