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ST JOSEPH'S MCAULEY PHARMACY
DSH160028 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
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Covered Entity Details
Entity Name
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM d/b/a CHI Health Mercy Council Bluffs
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160028
Entity Address
800 MERCY DRIVE
COUNCIL BLUFFS, IA 51503
Medicare Provider Number
160028
Participating Start Date
4/1/2005
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
500 W. THOMAS ROAD
SUITE 190
PHOENIX, AZ 85013
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nick O'Tool, Division VP Finance
(402) 717-8118
Contract Pharmacy Representative
St.Joseph's Hospital and Medical Center
Jeffrey Jackson, Chief Financial Officer
(602) 406-4618
Signed By Date
4/15/2019
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