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TOWNCREST PHARMACY BELLE PLAINE
CAH161306-00 ST. LUKE'S JONES REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S JONES REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161306-00
Entity Address
1795 HIGHWAY 64 EAST
ANAMOSA, IA 52205
Medicare Provider Number
161306
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
TOWNCREST PHARMACY BELLE PLAINE
Pharmacy Address
731 12TH ST.
BELLE PLAINE, IA 52208
Pharmacy Comments
Contract Details
Approval Date
4/9/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ERIC BRIESEMEISTER, CEO
(319) 481-6301
Contract Pharmacy Representative
Cornerstone Apothecary
Bethany Hoopes, Owner
(319) 444-2290
Signed By Date
4/9/2019
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