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COMMUNITY PHARMACY OF SAC CITY
SCH160016-00 TRINITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TRINITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160016-00
Entity Address
802 KENYON ROAD
FORT DODGE, IA 50501
Medicare Provider Number
160016
Participating Start Date
10/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
COMMUNITY PHARMACY OF SAC CITY
Pharmacy Address
501 W MAIN ST
SAC CITY, IA 50583
Pharmacy Comments
Contract Details
Approval Date
9/2/2022
Contract Begin Date
9/2/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sarah Marsh, Regional Vice President - Finance
(515) 574-6260
Contract Pharmacy Representative
Pharma340
Jane Moeller, Pharmacist
(712) 830-5443
Signed By Date
9/2/2022
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