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EAGLE PHARMACY
SCH160016-00 TRINITY REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
TRINITY REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160016-00
Entity Address
802 KENYON ROAD
FORT DODGE, IA 50501
Medicare Provider Number
160016
Participating Start Date
10/1/2015
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
EAGLE PHARMACY
Pharmacy Address
311 W BROADWAY ST
BOX 331
EAGLE GROVE, IA 50533-1711
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sarah Marsh, Regional Vice President - Finance
(515) 574-6260
Contract Pharmacy Representative
Eagle Grove Pharmacy
Andrew Wagner, Owner
(515) 448-3814
Signed By Date
7/12/2024
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