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ST JOSEPH'S MCAULEY PHARMACY
CAH161304-00 ALEGENT HEALTH - MERCY HOSPITAL, CORNING, IOWA d/b/a CHI Health Mercy Corning
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Covered Entity Details
Entity Name
ALEGENT HEALTH - MERCY HOSPITAL, CORNING, IOWA d/b/a CHI Health Mercy Corning
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161304-00
Entity Address
603 ROSARY DRIVE
CORNING, IA 50841
Medicare Provider Number
161304
Participating Start Date
9/29/2010
Last Recertification Date
8/20/2024
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
4/16/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Wolfe, ADMINISTRATOR
(641) 322-6270
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
4/16/2019
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