Contract Pharmacy Details

IOWA CVS PHARMACY, L.L.C.
DSH160083 CATHOLIC HEALTH INITIATIVES - IOWA, CORP

Covered Entity Details

Entity Name

CATHOLIC HEALTH INITIATIVES - IOWA, CORP

Subdivision Name

MERCYONE DES MOINES MEDICAL CENTER

Type

Disproportionate Share Hospital

340B ID

DSH160083

Entity Address

1111 6th Avenue
DES MOINES, IA 50314-2610

Medicare Provider Number

160083

Participating Start Date

4/1/2011

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

IOWA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY # 10480
14201 HICKMAN RD.
URBANDALE, IA 50323

Pharmacy Comments

Contract Details

Approval Date

4/7/2022

Contract Begin Date

7/1/2022

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/7/2022

340B Drug Pricing Program Database