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MEDICAP PHARMACY
CH07055A Primary Health Care, Inc.
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Covered Entity Details
Entity Name
Primary Health Care, Inc.
Subdivision Name
Primary Health Care - Bery Engebretsen Clinic
Type
HRSA-Funded Health Center
340B ID
CH07055A
Entity Address
2353 SE 14th St
Des Moines, IA 50320-1109
Grant Number
H80CS00715
Participating Start Date
7/1/2002
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
GRX HOLDINGS, LLC
2804 BEAVER AVENUE
DES MOINES, IA 50310
Pharmacy Comments
Contract Details
Approval Date
7/7/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Huntsman, CEO
(515) 248-1441
Contract Pharmacy Representative
GRX Holdings, LLC
Katie Thaut, Vice President of Operations
(515) 440-1270
Signed By Date
7/7/2023
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