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UNITYPOINT AT HOME
DSH160146 ST. LUKE'S REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160146
Entity Address
2720 STONE PARK BLVD
SIOUX CITY, IA 51104
Medicare Provider Number
160146
Participating Start Date
1/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
UNITYPOINT AT HOME
Pharmacy Address
11333 AURORA AVE
URBANDALE, IA 50322
Pharmacy Comments
Contract Details
Approval Date
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James L. Gobell, CFO
(712) 279-3949
Contract Pharmacy Representative
UnityPoint at Home
Ethan Middleton, Director Specialty Pharmacy
(515) 727-1160
Signed By Date
10/14/2021
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