Contract Pharmacy Details

NIGHTINGALE DRUG
CAH161312-00 GUTTENBERG MUNICIPAL HOSPITAL

Covered Entity Details

Entity Name

GUTTENBERG MUNICIPAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161312-00

Entity Address

200 Main Street
GUTTENBERG, IA 52052

Medicare Provider Number

161312

Participating Start Date

1/1/2019

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

NIGHTINGALE DRUG

Pharmacy Address

PRESCRIPTION SHOPPE, INC.
807 S HIGHWAY 52
GUTTENBERG, IA 52052

Pharmacy Comments

Contract Details

Approval Date

1/11/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lisa Manson, Director of Ambulatory Services
(563) 252-1121

Contract Pharmacy Representative

Pharmacy Care Centre
Linda Nightingale, Owner
(563) 581-2508

Signed By Date

1/11/2019

340B Drug Pricing Program Database