Contract Pharmacy Details

DBA NUCARA PHARMACY #11
CAH161344-00 WASHINGTON COUNTY HOSPITAL

Covered Entity Details

Entity Name

WASHINGTON COUNTY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161344-00

Entity Address

400 E POLK ST.
WASHINGTON, IA 52353

Medicare Provider Number

161344

Participating Start Date

9/27/2010

Last Recertification Date

8/30/2024

Pharmacy Details

Pharmacy Name

DBA NUCARA PHARMACY #11

Pharmacy Address

NUDAK VENTURES LLC
120 E MADISON ST.
BOX 534
WASHINGTON, IA 52353

Pharmacy Comments

Contract Details

Approval Date

6/20/2012

Contract Begin Date

6/20/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/1/2015
Pharmacy closed

Contacts

Covered Entity Signing Official

James Van Winkle, DIRECTOR OF PHARMACY SERVICES
(319) 863-3967

Contract Pharmacy Representative

Brian Wegmann, CEO
(641) 366-3440

Signed By Date

6/8/2012

340B Drug Pricing Program Database