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BRAD'S CORNER DRUG
CAH161338-00 MercyOne Oelwein Medical Center
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Covered Entity Details
Entity Name
MercyOne Oelwein Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161338-00
Entity Address
201 8TH AVE
OELWEIN, IA 50662-2447
Medicare Provider Number
161338
Participating Start Date
9/30/2010
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
BRAD'S CORNER DRUG
Pharmacy Address
L & B PHARMACY INC
103 E 18TH ST
CEDAR FALLS, IA 50613
Pharmacy Comments
Contract Details
Approval Date
7/23/2012
Contract Begin Date
7/23/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michele Panicucci, CFO / Senior Vice President
(319) 272-7359
Contract Pharmacy Representative
Bradley Harms, Owner
(319) 277-1829
Signed By Date
6/29/2012
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