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DOTZLER PHARMACIES, INC.
CAH161374-02 SHELBY CO CHRIS A MYRTUE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
SHELBY CO CHRIS A MYRTUE MEMORIAL HOSPITAL
Subdivision Name
Myrtue Medical Center Shelby RHC
Type
Critical Access Hospital
340B ID
CAH161374-02
Entity Address
301 East St.
Shelby, IA 51570
Medicare Provider Number
161374
Outpatient Facility Provider Number
161374
Participating Start Date
10/1/2014
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
DOTZLER PHARMACIES, INC.
Pharmacy Address
DBA PEXTON PHARMACY
1812 CHATBURN PLZ
HARLAN, IA 51537-1980
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry Jacobsen, CEO
(712) 755-4315
Contract Pharmacy Representative
Pexton Pharmacy
Rick Dotzler, President
(712) 755-2101
Signed By Date
4/17/2023
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