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DONLON DRUG, INC
CAH161371-00 Winneshiek Medical Center
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Covered Entity Details
Entity Name
Winneshiek Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161371-00
Entity Address
901 Montgomery St
Decorah, IA 52101
Medicare Provider Number
161371
Participating Start Date
7/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
DONLON DRUG, INC
Pharmacy Address
DBA DONLON PHARMACY
201 W. WATER ST
DECORAH, IA 52101
Pharmacy Comments
Contract Details
Approval Date
12/26/2019
Contract Begin Date
12/26/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/29/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Lynn Luloff, CFO
(563) 387-3109
Contract Pharmacy Representative
Donlon Drug, INC
Mark Branum, PIC
(563) 382-3929
Signed By Date
12/26/2019
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