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DSH160064AR MercyOne North Iowa Medical Center (Terminated)
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Main Details
Name
MercyOne North Iowa Medical Center
Subdivision Name
MercyOne North Iowa Integrative Medicine - Family & Sports Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160064AR
Medicare Provider Number
160064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/31/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/28/2024
Last Recertification Date
8/19/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
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
910 N Eisenhower Ave
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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Participating from effective date: (07/1/2023) until terminated effective date: (10/1/2023), reinstatement effective date: (04/1/2024)
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