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OWL PHARMACY
CAH161377-00 MercyOne Centerville Medical Center
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Covered Entity Details
Entity Name
MercyOne Centerville Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161377-00
Entity Address
ONE ST. JOSEPH'S DRIVE
CENTERVILLE, IA 52544
Medicare Provider Number
161377
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
OWL PHARMACY
Pharmacy Address
213 N 13TH ST
CENTERVILLE, IA 52544-1707
Pharmacy Comments
Contract Details
Approval Date
7/25/2012
Contract Begin Date
7/25/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Rathbun, CFO
(641) 437-3442
Contract Pharmacy Representative
Owl Pharmacy
FRANK REZNICEK, OWNER/OPERATOR
(641) 895-6368
Signed By Date
7/20/2012
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