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LEWIS FAMILY DRUG #39
CAH161346-00 SIOUX CENTER HEALTH
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Covered Entity Details
Entity Name
SIOUX CENTER HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161346-00
Entity Address
1101 9th St SE
SIOUX CENTER, IA 51250-1398
Medicare Provider Number
161346
Participating Start Date
9/28/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
LEWIS FAMILY DRUG #39
Pharmacy Address
521 BLACK FOREST RD
STE 5
HULL, IA 51239
Pharmacy Comments
Contract Details
Approval Date
1/4/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KAYLEEN LEE, CHIEF EXECUTIVE OFFICER
(712) 722-1271
Contract Pharmacy Representative
Lewis Drug
Scott Cross, EVP
(605) 367-2800
Signed By Date
1/4/2017
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