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DSH160058AR UNIVERSITY OF IOWA HOSPITALS & CLINICS (Terminated)
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Main Details
Name
UNIVERSITY OF IOWA HOSPITALS & CLINICS
Subdivision Name
UNIVERSITY OF IOWA HOSPITALS & CLIN - IRL EAST - RESPIRATORY THERAPY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160058AR
Medicare Provider Number
160058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/24/2023
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
4/1/2024
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
University of Iowa Health Care
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Primary Contact
University of Iowa Health Care
Becky Marie Triplett, Manager, 340B and Compliance
(319) 384-5583
Addresses
Street Address
920 E 2ND AVE
CORALVILLE, IA 52241-2219
Billing Address
UNIVERSITY OF IOWA ACCOUNTS PAYABLE
202 PCO
IOWA CITY, IA 52242
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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