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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #10855
1850 LOGAN AVE
WATERLOO, IA 50703
Pharmacy Comments
Contract Details
Approval Date
4/9/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/2/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHELE PANICUCCI, SENIOR VP/CFO
(319) 272-7359
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/9/2013
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