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CAREMARK PUERTO RICO SPECIALTY PHARMACY,
DSH160083 CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH160083
Entity Address
1111 6th Avenue
DES MOINES, IA 50314-2610
Medicare Provider Number
160083
Participating Start Date
4/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CAREMARK PUERTO RICO SPECIALTY PHARMACY,
Pharmacy Address
CAREMARK PUERTO RICO SPECIALTY PHARMACY
6020 AVE ROBERTO SANCHEZ VILELLA
CAROLINA, PR 00982
Pharmacy Comments
Contract Details
Approval Date
7/10/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/7/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860
Contract Pharmacy Representative
Catholic Health Initiatives, Iowa Corp
Candace Marie Jordan, Mkt Director of Pharmacy
(515) 247-3262
Signed By Date
7/10/2020
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