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MEDICAP PHARMACY
CAH161314-00 Guthrie County Hospital
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Covered Entity Details
Entity Name
Guthrie County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161314-00
Entity Address
710 North 12th Street
Guthrie Center, IA 50115
Medicare Provider Number
161314
Participating Start Date
1/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
GRX HOLDINGS, LLC
615 E. MAIN STREET
PANORA, IA 50216-1097
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Troy Eller, CFO
(641) 332-3833
Contract Pharmacy Representative
GRX Holdings, LLC
GREG JOHANSEN, PRESIDENT
(515) 440-1270
Signed By Date
7/11/2018
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