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CHI HEALTH PHARMACY - LAKESIDE
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
CHI HEALTH PHARMACY - LAKESIDE
Pharmacy Address
16909 LAKESIDE HILLS CT STE 107
OMAHA, NE 68130-4661
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/11/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Wolfe, ADMINISTRATOR
(641) 322-6270
Contract Pharmacy Representative
CHI Health
Gregory Schardt, Division Director of Pharmacy Operations
(402) 206-3370
Signed By Date
10/11/2019
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