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THRIFTY WHITE PHARMACY #049
CAH161302-00 IOWA SPECIALTY HOSPITAL - CLARION
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Covered Entity Details
Entity Name
IOWA SPECIALTY HOSPITAL - CLARION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161302-00
Entity Address
1316 S Main St
CLARION, IA 50525
Medicare Provider Number
161302
Participating Start Date
9/14/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #049
Pharmacy Address
848 SECOND ST
WEBSTER CITY, IA 50595
Pharmacy Comments
Contract Details
Approval Date
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/7/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GREG POLZIN, CFO
(641) 444-5623
Contract Pharmacy Representative
THRIFTY WHITE
Alicia Hager, Pharmacy Operations Specialist
(763) 463-4482
Signed By Date
7/16/2014
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