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DRUGTOWN DRUGSTORE #5 7026
DSH160045 ST LUKES METHODIST HOSPITAL
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Covered Entity Details
Entity Name
ST LUKES METHODIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160045
Entity Address
1026 A AVENUE NE
CEDAR RAPIDS, IA 52402-3026
Medicare Provider Number
160045
Participating Start Date
1/1/2014
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
DRUGTOWN DRUGSTORE #5 7026
Pharmacy Address
2001 BLAIRS FERRY ROAD NE
CEDAR RAPIDS, IA 52402
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucas Hicks, VP - Finance
(319) 369-8114
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
1/15/2025
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