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LEWIS DRUG DISTRIBUTION CENTER
CAH161345-00 OSCEOLA COMMUNITY HOSPITAL
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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 DRUG DISTRIBUTION CENTER
Pharmacy Address
700 E 54TH ST N
SIOUX FALLS, SD 57104
Pharmacy Comments
Contract Details
Approval Date
7/6/2012
Contract Begin Date
7/6/2012
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
6/25/2012
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