340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HERITAGE PHARMACY - FORT MADISON
DSH160057 Southeast Iowa Regional Medical Center
Print
Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160057
Entity Address
1221 SOUTH GEAR AVENUE
WEST BURLINGTON, IA 52655
Medicare Provider Number
160057
Participating Start Date
4/1/2022
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HERITAGE PHARMACY - FORT MADISON
Pharmacy Address
SOUTHEAST IOWA REGIONAL MEDICAL CENTER
3032 AVENUE L
SUITE 3
FORT MADISON, IA 52627
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeremy Alexander, Chief Financial Officer
(319) 768-3280
Contract Pharmacy Representative
SEIRMC
Steve Frigo, VP
(319) 768-3971
Signed By Date
7/3/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session