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CHI HEALTH PHARMACY - IMMANUEL
CAH161309-00 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
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Covered Entity Details
Entity Name
ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL d/b/a CHI Health Missouri Valley
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161309-00
Entity Address
631 N. 8TH STREET
MISSOURI VALLEY, IA 51555
Medicare Provider Number
161309
Participating Start Date
9/29/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CHI HEALTH PHARMACY - IMMANUEL
Pharmacy Address
6829 N 72ND ST STE 2160
OMAHA, NE 68122
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
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
Jonathan Dean Moe, President
(712) 642-9208
Contract Pharmacy Representative
CHI Health
Gregory Schardt, Division Director of Pharmacy Operations
(402) 206-3370
Signed By Date
10/14/2019
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