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HERITAGE PARK PHARMACY
CH07731A COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA KHS KEOKUK CLINIC
Type
HRSA-Funded Health Center
340B ID
CH07731A
Entity Address
400 N 17th St
Keokuk, IA 52632-3452
Grant Number
H80CS00272
Participating Start Date
1/1/2004
Last Recertification Date
2/9/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
HERITAGE PARK PHARMACY
Pharmacy Address
1223 S GEAR AVE STE 105
WEST BURLINGTON, IA 52655-1690
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
RONALD KEMP, CEO
(319) 753-2300 Ext: 100
Contract Pharmacy Representative
Great River Health System
Brian J. Anderson, Director of Pharmacies
(319) 768-3950
Signed By Date
7/14/2017
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