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Walgreens Central Fill #21394
DSH160083 CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH160083
Entity Address
1111 6th Avenue
DES MOINES, IA 50314-2610
Medicare Provider Number
160083
Participating Start Date
4/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
Walgreens Central Fill #21394
Pharmacy Address
2601 Hughes Road
Suite 103
Liberty, MO 64068
Pharmacy Comments
Contract Details
Approval Date
1/4/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jodie Lynn Roettger, Interim Chief Financial Officer
(515) 358-9267
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/4/2024
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