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NUDAK VENTURES LLC
STD503209 Iowa Department of Health and Human Services
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Covered Entity Details
Entity Name
Iowa Department of Health and Human Services
Subdivision Name
STI Program
Type
Sexually Transmitted Diseases
340B ID
STD503209
Entity Address
LUCAS STATE OFFICE BLDG
321 EAST 12TH STREET
DES MOINES, IA 50319-0075
Grant Number
NH25PS005158
Participating Start Date
4/1/2000
Last Recertification Date
5/9/2025
Pharmacy Details
Pharmacy Name
NUDAK VENTURES LLC
Pharmacy Address
NUCARA PHARMACY #27
4927 MAPLE DR
PLEASANT HILL, IA 50327
Pharmacy Comments
01/09/2013 name, address update(was NJL INC. PHARMACY SERVICES 4929 MAPLE DRIVE 50317)
Contract Details
Approval Date
4/1/2000
Contract Begin Date
4/1/2000
Carve-In Effective Date
Contract Comments
SITE WAS REINSTATED 4/1/2000, ORIGINAL CP DATE IS FROM 7/1/99 TO 12/31/99
Contract Termination Date
Termination Reason
6/10/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
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