340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
MERCYONE DES MOINES PHARMACY
DSH160083D CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Print
Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MercyOne Des Moines Ambulatory Surgery
Type
Disproportionate Share Hospital
340B ID
DSH160083D
Entity Address
411 LAUREL ST
Suite 1100
DES MOINES, IA 50314
Medicare Provider Number
160083
Outpatient Facility Provider Number
Participating Start Date
4/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
MERCYONE DES MOINES PHARMACY
Pharmacy Address
1111 6TH AVE
DES MOINES, IA 50314-2613
Pharmacy Comments
Contract Details
Approval Date
9/5/2012
Contract Begin Date
9/5/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Kukla, Director of Pharmacy
(515) 643-4550
Contract Pharmacy Representative
Catholice Health Initiatives, Iowa Corp.
Gregory A. Young, DIRECTOR OF PHARMACY
(515) 247-3262
Signed By Date
8/15/2012
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