Contract Pharmacy Details

HUGHES PHARMACY
DSH160064 MercyOne North Iowa Medical Center

Covered Entity Details

Entity Name

MercyOne North Iowa Medical Center

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH160064

Entity Address

1000 4TH STREET SW
MASON CITY, IA 50401

Medicare Provider Number

160064

Participating Start Date

10/1/2019

Last Recertification Date

8/19/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

HUGHES PHARMACY

Pharmacy Address

2216 MAIN ST
EMMETSBURG, IA 50536-2447

Pharmacy Comments

Contract Details

Approval Date

7/26/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

DANETTE ZOOK, RHM VP Finance
(641) 428-7989

Contract Pharmacy Representative

Hughes
Steven Hoyman, Owner
(712) 852-3433

Signed By Date

7/12/2019