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WALGREEN CO.
CAH161309-00 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
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Covered Entity Details
Entity Name
ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161309-00
Entity Address
631 N. 8TH STREET
MISSOURI VALLEY, IA 51555
Medicare Provider Number
161309
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY#16270
240 S. 77TH ST
OMAHA, NE 68114
Pharmacy Comments
Contract Details
Approval Date
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT VALENTINE, ADMINISTRATOR
(712) 642-2784
Contract Pharmacy Representative
CHI Health Missouri Valley
ROBERT VALENTINE, ADMINISTRATOR
(712) 642-2784
Signed By Date
7/10/2018
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