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TOWNCREST PHARMACY NEW HAMPTON
CAH161331-00 Mercy Medical Center New Hampton
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Covered Entity Details
Entity Name
Mercy Medical Center New Hampton
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161331-00
Entity Address
308 NORTH MAPLE AVENUE
NEW HAMPTON, IA 50659
Medicare Provider Number
161331
Participating Start Date
4/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
TOWNCREST PHARMACY NEW HAMPTON
Pharmacy Address
1 W MAIN ST
P.O.BOX 111
NEW HAMPTON, IA 50659
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNIFER RAPENSKE, REGIONAL CFO
(641) 394-1682
Contract Pharmacy Representative
Towncrest Pharmacy Corp
Randy McDonough, CEO
(319) 337-3526
Signed By Date
4/14/2014
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