Contract Pharmacy Details

LEWIS FAMILY DRUG #67
CAH161345-00 OSCEOLA COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

OSCEOLA COMMUNITY HOSPITAL

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161345-00

Entity Address

600 9TH AVENUE NORTH
SIBLEY, IA 51249

Medicare Provider Number

161345

Participating Start Date

9/27/2010

Last Recertification Date

8/16/2024

Pharmacy Details

Pharmacy Name

LEWIS FAMILY DRUG #67

Pharmacy Address

LEWIS FAMILY DRUG LLC
420 2ND AVE
SIBLEY, IA 51249-1205

Pharmacy Comments

Contract Details

Approval Date

6/4/2012

Contract Begin Date

6/4/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/20/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

JANET DYKSTRA, CEO
(712) 754-2574 Ext: 218

Contract Pharmacy Representative

Lewis Drug
Scott Cross, EVP
(605) 367-2800

Signed By Date

5/8/2012

340B Drug Pricing Program Database