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LAGRANGE PHARMACY INC
CAH161349-02 Virginia Gay Hospital
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Covered Entity Details
Entity Name
Virginia Gay Hospital
Subdivision Name
Vinton Family Medical Clinic
Type
Critical Access Hospital
340B ID
CAH161349-02
Entity Address
504 N 9th Ave
Vinton, IA 52349
Medicare Provider Number
161349
Outpatient Facility Provider Number
163461
Participating Start Date
7/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
LAGRANGE PHARMACY INC
Pharmacy Address
LAGRANGE PHARMACY
111 W 4TH ST
VINTON, IA 52349
Pharmacy Comments
Contract Details
Approval Date
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Euan Macgregor, Chief Operating Officer
(319) 472-6379
Contract Pharmacy Representative
La Grange Pharmacy
Dan Lagrange, Owner
(319) 472-4274
Signed By Date
4/5/2023
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