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WELLS HOMETOWN DRUG
CAH161327-00 DAVIS COUNTY HOSPITAL
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Covered Entity Details
Entity Name
DAVIS COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161327-00
Entity Address
509 N. MADISON ST.
BLOOMFIELD, IA 52537-1271
Medicare Provider Number
161327
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WELLS HOMETOWN DRUG
Pharmacy Address
WELLS BROS. PHARMACY SERVICES, LLC
208 E FRANKLIN ST
BLOOMFIELD, IA 52537-1685
Pharmacy Comments
Contract Details
Approval Date
4/1/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kendra Warning, CFO
(641) 664-7081
Contract Pharmacy Representative
WELLS HOMETOWN DRUG
MYLO WELLS, OWNER - PHARMACIST
(641) 664-3100
Signed By Date
4/1/2019
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