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CHEROKEE MAIN STREET PHARMACY
CAH161362-00 SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161362-00
Entity Address
300 SIOUX VALLEY DRIVE
CHEROKEE, IA 51012
Medicare Provider Number
161362
Participating Start Date
9/30/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
CHEROKEE MAIN STREET PHARMACY
Pharmacy Address
218 E MAIN ST
CHEROKEE, IA 51012
Pharmacy Comments
Contract Details
Approval Date
4/3/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2022
Ownership change
Contacts
Covered Entity Signing Official
JOHN M. COMSTOCK, CEO
(712) 225-1505
Contract Pharmacy Representative
CMSRx Inc.
Anthony Puffett, President
(712) 225-2320
Signed By Date
4/3/2015
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