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MERCYONE ANKENY PHARMACY
DSH160083M CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MercyOne West Des Moines Outpatient Cardiac Testing
Type
Disproportionate Share Hospital
340B ID
DSH160083M
Entity Address
5880 UNIVERSITY AVE
STE 211
WEST DES MOINES, IA 50266
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 ANKENY PHARMACY
Pharmacy Address
800 E 1ST ST STE 1800
ANKENY, IA 50021-2100
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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