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ACCREDO HEALTH GROUP, INC.
DSH160057AA Southeast Iowa Regional Medical Center
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Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
MENTAL HEALTH-SOUTHEAST IOWA REGION - Mental Health
Type
Disproportionate Share Hospital
340B ID
DSH160057AA
Entity Address
1225 S GEAR AVE
STE 251
WEST BURLINGTON, IA 52655-1688
Medicare Provider Number
160057
Outpatient Facility Provider Number
Participating Start Date
4/1/2022
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
2/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeremy Alexander, CFO
(319) 768-3280
Contract Pharmacy Representative
Southeast Iowa Regional Medical Center
Steve Frigo, Director, Pharmacy
(319) 768-3971
Signed By Date
2/18/2022
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