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IOWA CVS PHARMACY, L.L.C.
CAH141319-00 Henry District Hospital
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Covered Entity Details
Entity Name
Henry District Hospital
Subdivision Name
Hammond Henry Hospital
Type
Critical Access Hospital
340B ID
CAH141319-00
Entity Address
600 North College Ave
Geneseo, IL 61254-1099
Medicare Provider Number
141319
Participating Start Date
10/1/2012
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
IOWA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08659
1777 DIVISION ST.
DAVENPORT, IA 52804
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
7/20/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura J Domino, Vice President of Patient Care Services
(309) 944-9101
Contract Pharmacy Representative
Hammond-Henry Hospital
Laura J Domino, Vice President of Patient Care Services
(309) 944-9101
Signed By Date
7/9/2021
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