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WELLS HOMETOWN DRUG
CAH161337-00 VAN BUREN COUNTY HOSPITAL
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Covered Entity Details
Entity Name
VAN BUREN COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161337-00
Entity Address
304 FRANKLIN STREET
KEOSAUQUA, IA 52565-0070
Medicare Provider Number
161337
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WELLS HOMETOWN DRUG
Pharmacy Address
WELLS BROS. PHARMACY SERVICES, LLC
208 E FRANKLIN ST
BLOOMFIELD, IA 52537-1685
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kara McEntee, CFO
(319) 293-8722
Contract Pharmacy Representative
WELLS HOMETOWN DRUG
MYLO WELLS, OWNER - PHARMACIST
(641) 664-3100
Signed By Date
10/14/2019
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