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WRIGHT PHARMACY
CAH161322-00 Dallas County Hospital
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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
WRIGHT PHARMACY
Pharmacy Address
GRX HOLDINGS, LLC
303 SW 7TH STREET
SUITE A
STUART, IA 50250-0159
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
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