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OWL PHARMACY
CAH161377-00 MercyOne Centerville Medical Center
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Covered Entity Details
Entity Name
MercyOne Centerville Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161377-00
Entity Address
ONE ST. JOSEPH'S DRIVE
CENTERVILLE, IA 52544
Medicare Provider Number
161377
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OWL PHARMACY
Pharmacy Address
213 N 13TH ST
CENTERVILLE, IA 52544-1707
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
Contract Begin Date
7/7/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MATTHEW DONALD JOHNSON, President
(641) 437-3411
Contract Pharmacy Representative
Owl Pharmacy
Clark D Bishop, Co-Owner/Managing Member
(580) 363-2137
Signed By Date
7/7/2021
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