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MERCYONE DES MOINES PHARMACY
DSH160083J CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES CARDIAC & PULMONARY PREVENTION AND REHABILITATION
Type
Disproportionate Share Hospital
340B ID
DSH160083J
Entity Address
411 Laurel St
Suite 2275
DES MOINES, IA 50314
Medicare Provider Number
160083
Outpatient Facility Provider Number
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
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
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