340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MEDICAP PHARMACY
CAH161322-00 Dallas County Hospital
Print
Covered Entity Details
Entity Name
Dallas County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161322-00
Entity Address
610 10th Street
Perry, IA 50220
Medicare Provider Number
161322
Participating Start Date
10/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
504 14TH STREET
PO BOX 369
P.O. BOX 369
DALLAS CENTER, IA 50063
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/25/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Mortoza, Chief Executive Officer
(515) 465-7628
Contract Pharmacy Representative
GRX Holdings, LLC
Katie Thaut, Vice President of Operations
(515) 440-1270
Signed By Date
10/14/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session