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UNITYPOINT AT HOME
DSH160110 Allen Memorial Hospital Corporation
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Covered Entity Details
Entity Name
Allen Memorial Hospital Corporation
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160110
Entity Address
1825 Logan Avenue
Waterloo, IA 50703-1916
Medicare Provider Number
160110
Participating Start Date
1/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
UNITYPOINT AT HOME
Pharmacy Address
11333 AURORA AVE
URBANDALE, IA 50322
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Carpenter, Regional Vice President/CFO
(319) 235-3918
Contract Pharmacy Representative
UnityPoint at Home
Chad Mentele, Director of Specialty Pharmacy
(515) 557-3267
Signed By Date
10/17/2016
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