Contract Pharmacy Details

IOWA CVS PHARMACY, L.L.C.
CAH161367-00 PELLA REGIONAL HEALTH CENTER

Covered Entity Details

Entity Name

PELLA REGIONAL HEALTH CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161367-00

Entity Address

404 JEFFERSON ST.
PELLA, IA 50219

Medicare Provider Number

161367

Participating Start Date

1/1/2011

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

IOWA CVS PHARMACY, L.L.C.

Pharmacy Address

CVS PHARMACY # 17056
3414 8TH ST SW
ALTOONA, IA 50009

Pharmacy Comments

Contract Details

Approval Date

1/9/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

12/15/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Dawnett Willis, Chief Ancillary Services Officer
(641) 621-2480

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/9/2020

340B Drug Pricing Program Database