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AMBER ENTERPRISES, INC
CAH161344-00 WASHINGTON COUNTY HOSPITAL
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Covered Entity Details
Entity Name
WASHINGTON COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161344-00
Entity Address
400 E POLK ST.
WASHINGTON, IA 52353
Medicare Provider Number
161344
Participating Start Date
9/27/2010
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
AMBER ENTERPRISES, INC
Pharmacy Address
DBA AMBER SPECIALTY PHARMACY
1 E ERIE ST STE 630
CHICAGO, IL 60611
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shelli Cleverley, CFO
(319) 863-3902
Contract Pharmacy Representative
Amber Pharmacy
Kelley Miller, Manager, Business Development
(800) 921-1573
Signed By Date
1/15/2019
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