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MERCYONE DUBUQUE WEST PHARMACY
CH071927C Crescent Community Health Center
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Covered Entity Details
Entity Name
Crescent Community Health Center
Subdivision Name
Crescent Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH071927C
Entity Address
1690 Elm Street STE 250
Dubuque, IA 52001-3686
Grant Number
H80CS08765
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MERCYONE DUBUQUE WEST PHARMACY
Pharmacy Address
1500 ASSOCIATES DR
DUBUQUE, IA 52002
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Collins, CEO
(563) 690-2860
Contract Pharmacy Representative
MercyOne
Jessica Smith, Outpatient Pharmacy Supervisor
(563) 588-4033
Signed By Date
4/10/2023
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