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ACCREDO HEALTH GROUP INC
CAH161363-00 Montgomery County Memorial Hospital
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Covered Entity Details
Entity Name
Montgomery County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161363-00
Entity Address
2301 Eastern Avenue
Red Oak, IA 51566
Medicare Provider Number
161363
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP INC
Pharmacy Address
1620 CENTURY CENTER PKWY
# 109
MEMPHIS, TN 38134-8849
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/5/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rick J. Leinen, Chief Financial Officer
(712) 623-7150
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/14/2022
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