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SHOPKO PHARMACY #2687
CAH161310-00 ADAIR COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
ADAIR COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161310-00
Entity Address
609 SE KENT STREET
GREENFIELD, IA 50849-9494
Medicare Provider Number
161310
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2687
Pharmacy Address
202 SW KENT ST
GREENFIELD, IA 50849
Pharmacy Comments
Contract Details
Approval Date
7/15/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/11/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Kevin Heinzeroth, CFO
(641) 743-7238
Contract Pharmacy Representative
Shopko
Tad Schilke, Director of Rx Merchandising & Marketing
(920) 429-7628
Signed By Date
7/15/2014
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