340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HERITAGE PARK PHARMACY
RRC160057-00 Southeast Iowa Regional Medical Center
Print
Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
Type
Rural Referral Center
340B ID
RRC160057-00
Entity Address
1221 S. GEAR
WEST BURLINGTON, IA 52655
Medicare Provider Number
160057
Participating Start Date
1/1/2011
Last Recertification Date
9/10/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
HERITAGE PARK PHARMACY
Pharmacy Address
1223 S GEAR AVE STE 105
WEST BURLINGTON, IA 52655-1690
Pharmacy Comments
Contract Details
Approval Date
12/29/2010
Contract Begin Date
1/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/6/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
12/23/2010
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session