340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ELK HORN PHARMACY
CAH161374-00 SHELBY CO CHRIS A MYRTUE MEMORIAL HOSPITAL
Print
Covered Entity Details
Entity Name
SHELBY CO CHRIS A MYRTUE MEMORIAL HOSPITAL
Subdivision Name
DBA MYRTUE MEDICAL CENTER
Type
Critical Access Hospital
340B ID
CAH161374-00
Entity Address
1213 GARFIELD AVE
HARLAN, IA 51537
Medicare Provider Number
161374
Participating Start Date
4/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ELK HORN PHARMACY
Pharmacy Address
4022 MAIN STREET
PO BOX 355
ELK HORN, IA 51531
Pharmacy Comments
Contract Details
Approval Date
1/17/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Barry Jacobsen, CEO
(712) 755-4315
Contract Pharmacy Representative
Elk Horn Pharmacy
Tim Waymire, Rph/ President
(712) 764-2334
Signed By Date
1/17/2014
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