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COMMCARE PHARMACY-FTL, LLC
CAH261328-00 NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
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Covered Entity Details
Entity Name
NORTHWEST MEDICAL CENTER ASSOCIATION, INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261328-00
Entity Address
705 N. COLLEGE
ALBANY, MO 64402-1433
Medicare Provider Number
261328
Participating Start Date
9/24/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
COMMCARE PHARMACY-FTL, LLC
Pharmacy Address
855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/12/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
JON David DOOLITTLE, PRESIDENT & CEO
(660) 726-3941 Ext: 1177
Contract Pharmacy Representative
Greg Isaak, CEO
(954) 334-5965
Signed By Date
4/15/2016
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