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KOERNER WHIPPLE PHARMACIES INC.
CAH161301-00 BELMOND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
BELMOND COMMUNITY HOSPITAL
Subdivision Name
DBA IOWA SPECIALTY HOSPITAL - BELMOND
Type
Critical Access Hospital
340B ID
CAH161301-00
Entity Address
403 1ST STREET SE
BELMOND, IA 50421
Medicare Provider Number
161301
Participating Start Date
9/27/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
KOERNER WHIPPLE PHARMACIES INC.
Pharmacy Address
KOERNER WHIPPLE PHARMACY
104 1ST ST NW
HAMPTON, IA 50441
Pharmacy Comments
Contract Details
Approval Date
1/10/2022
Contract Begin Date
2/14/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG POLZIN, CFO
(641) 444-5623
Contract Pharmacy Representative
KOERNER DRUG
Todd Wragge, Owner and Pharmacist
(641) 456-2510
Signed By Date
1/10/2022
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