340B Drug Pricing Program Database
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DSH160033AV GENESIS MEDICAL CENTER - DAVENPORT (Active)
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Main Details
Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
GENESIS DAVENPORT HEADACHE CLINIC - Headache Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH160033AV
Medicare Provider Number
160033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/1/2023
Last Recertification Date
8/16/2024
Contacts
Authorizing Official
MercyOne Genesis Davenport
Christopher Michael Crome, Chief Operating Officer
(563) 421-6502
Primary Contact
Genesis Health System
Adam Baird, Director of Pharmacy
(563) 421-6212
Addresses
Street Address
1230 E. RUSHOLME ST
MOB 2 SUITE 207
DAVENPORT, IA 52803
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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