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STERLING SPECIALTY PHARMACY
DSH160067 MercyOne Waterloo Medical Center
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Covered Entity Details
Entity Name
MercyOne Waterloo Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160067
Entity Address
3421 W 9TH STREET
WATERLOO, IA 50702
Medicare Provider Number
160067
Participating Start Date
1/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
STERLING SPECIALTY PHARMACY
Pharmacy Address
1312 NORTHLAND DRIVE
SUITE 500
MENDOTA HEIGHTS, MN 55120-1140
Pharmacy Comments
Contract Details
Approval Date
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Douglas Davenport, Chief Financial Officer
(319) 272-7359
Contract Pharmacy Representative
Sterling Specialty Pharmacy
Lyle Prussman, Director of Pharmacy
(507) 519-2337
Signed By Date
10/10/2019
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