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GRX HOLDINGS, LLC
CAH161330-00 AUDUBON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
AUDUBON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161330-00
Entity Address
515 PACIFIC AVE
AUDUBON, IA 50025
Medicare Provider Number
161330
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
GRX HOLDINGS, LLC
Pharmacy Address
MEDICAP PHARMACY
317 N MARKET ST
AUDUBON, IA 50025-7562
Pharmacy Comments
Contract Details
Approval Date
10/2/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
THOMAS SMITH, CEO
(712) 563-5301
Contract Pharmacy Representative
Karen Merrill, Pharmacy Manager
(515) 280-2910
Signed By Date
10/2/2014
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