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UNITYPOINT AT HOME
DSH160082 IOWA METHODIST MEDICAL CENTER
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Covered Entity Details
Entity Name
IOWA METHODIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160082
Entity Address
1200 PLEASANT STREET
DES MOINES, IA 50309
Medicare Provider Number
160082
Participating Start Date
7/1/2017
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
UNITYPOINT AT HOME
Pharmacy Address
11333 AURORA AVE
URBANDALE, IA 50322
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Lothe, SVP/COO
(515) 241-5858
Contract Pharmacy Representative
UnityPoint at Home
Chad Mentele, Director of Specialty Pharmacy
(515) 557-3267
Signed By Date
10/16/2017
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