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SCOTT PHARMACY
CAH161331-00 Mercy Medical Center New Hampton
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Covered Entity Details
Entity Name
Mercy Medical Center New Hampton
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161331-00
Entity Address
308 NORTH MAPLE AVENUE
NEW HAMPTON, IA 50659
Medicare Provider Number
161331
Participating Start Date
4/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
SCOTT PHARMACY
Pharmacy Address
238 S MAIN ST
PO BOX 188
FAYETTE, IA 52142
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNIFER RAPENSKE, REGIONAL CFO
(641) 394-1682
Contract Pharmacy Representative
Scott Pharmacy
David Scott, Pharmacist
(563) 425-4530
Signed By Date
7/11/2019
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