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LEWIS FAMILY DRUG #55
CAH161359-00 BURGESS HEALTH CENTER
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Covered Entity Details
Entity Name
BURGESS HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161359-00
Entity Address
1600 DIAMOND STREET
ONAWA, IA 51040
Medicare Provider Number
161359
Participating Start Date
9/2/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
LEWIS FAMILY DRUG #55
Pharmacy Address
401 2ND ST
IDA GROVE, IA 51445-1302
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Johnathan R Wilker, VP Finance
(712) 423-9213
Contract Pharmacy Representative
Lewis Drug
Scott Cross, EVP
(605) 367-2800
Signed By Date
7/9/2021
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