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HARTIG DRUG COMPANY
CAH161312-01 GUTTENBERG MUNICIPAL HOSPITAL
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Covered Entity Details
Entity Name
GUTTENBERG MUNICIPAL HOSPITAL
Subdivision Name
Cornerstone Family Practice
Type
Critical Access Hospital
340B ID
CAH161312-01
Entity Address
200 MAIN ST
CORNERSTONE FAMILY PRACTICE
GUTTENBERG, IA 52052-9108
Medicare Provider Number
161312
Outpatient Facility Provider Number
168552
Participating Start Date
1/1/2019
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HARTIG DRUG COMPANY
Pharmacy Address
STONE CREEK SHOPPING CENTER
711 16TH AVE SE
DYERSVILLE, IA 52040
Pharmacy Comments
Contract Details
Approval Date
1/14/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/12/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Manson, Director of Ambulatory Services
(563) 252-1121
Contract Pharmacy Representative
Hartig Drug Company
Charles S Hartig, VP & GC
(563) 588-8700 Ext: 10012
Signed By Date
1/14/2019
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