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SHOPKO PHARMACY #2689
CAH161373-00 RINGGOLD COUNTY HOSPITAL
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Covered Entity Details
Entity Name
RINGGOLD COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161373-00
Entity Address
504 N. CLEVELAND ST.
MOUNT AYR, IA 50854-2201
Medicare Provider Number
161373
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2689
Pharmacy Address
201 N FILLMORE ST
MOUNT AYR, IA 50854
Pharmacy Comments
Contract Details
Approval Date
4/12/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
TERESA ROBERTS, CHIEF FINANCIAL OFFICER
(641) 464-4422
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
4/12/2016
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