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SPRING CITY PHARMACY, LLC
CAH161367-00 PELLA REGIONAL HEALTH CENTER
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Covered Entity Details
Entity Name
PELLA REGIONAL HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161367-00
Entity Address
404 JEFFERSON ST.
PELLA, IA 50219
Medicare Provider Number
161367
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
SPRING CITY PHARMACY, LLC
Pharmacy Address
101 N WALNUT ST
COLFAX, IA 50054
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
Jody VanVeen, Chief Nursing and Chief Ancillary Officer
(641) 628-6629
Contract Pharmacy Representative
Spring City Pharmacy
Brittney Van Houweling, Pharmacist/ Owner
(515) 674-3784
Signed By Date
7/3/2024
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