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DBA NUCARA PHARMACY #9
CAH161333-00 STORY COUNTY HOSPITAL DBA STORY COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
STORY COUNTY HOSPITAL DBA STORY COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161333-00
Entity Address
640 SOUTH 19TH STREET
NEVADA, IA 50201
Medicare Provider Number
161333
Participating Start Date
9/29/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
DBA NUCARA PHARMACY #9
Pharmacy Address
NUDAK VENTURES LLC
1002 6TH ST
PO BOX 541
NEVADA, IA 50201-1826
Pharmacy Comments
Contract Details
Approval Date
6/22/2012
Contract Begin Date
6/22/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
TODD WILLERT, CEO
(515) 382-7700
Contract Pharmacy Representative
Brett Barker, Director of Clinical Services
(515) 382-2485
Signed By Date
6/15/2012
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