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WAL-MART PHARMACY 10-0559
DSH160058 UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF IOWA HEALTH CARE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160058
Entity Address
200 HAWKINS DRIVE
IOWA CITY, IA 52242
Medicare Provider Number
160058
Participating Start Date
10/1/1999
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-0559
Pharmacy Address
3003 N HIGHWAY 61
MUSCATINE, IA 52761
Pharmacy Comments
Contract Details
Approval Date
4/21/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Brownlee, Chief Pharmacy Officer
(319) 384-9371
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/21/2020
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