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MEDICAP PHARMACY
CAH161372-00 BOONE COUNTY HOSPITAL
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Covered Entity Details
Entity Name
BOONE COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161372-00
Entity Address
1015 UNION STREET
BOONE, IA 50036
Medicare Provider Number
161372
Participating Start Date
9/2/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
403 STORY ST
BOONE, IA 50036-3533
Pharmacy Comments
Contract Details
Approval Date
1/18/2012
Contract Begin Date
1/18/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/20/2017
Ownership change
Contacts
Covered Entity Signing Official
DAVID MELLETT, Chief Financial Officer
(515) 433-8461
Contract Pharmacy Representative
James Carlson, Owner
(515) 432-2311
Signed By Date
1/10/2012
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