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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
CC ANDERSON, PC
411 ANNEX RD
MADRID, IA 50156-1471
Pharmacy Comments
Contract Details
Approval Date
4/10/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
DAVID MELLETT, CHIEF FINANCIAL OFFICER
(515) 433-8461
Contract Pharmacy Representative
Christy Anderson, R.pH
(515) 795-4252
Signed By Date
4/10/2013
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