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MERCYONE FOREST PARK PHARMACY
SCH160064-00 MERCYONE NORTH IOWA MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCYONE NORTH IOWA MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160064-00
Entity Address
1000 4TH STREET SW
MASON CITY, IA 50401
Medicare Provider Number
160064
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
MERCYONE FOREST PARK PHARMACY
Pharmacy Address
1010 4TH ST SW STE110
MASON CITY, IA 50401-2801
Pharmacy Comments
Contract Details
Approval Date
9/9/2011
Contract Begin Date
9/9/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
RODNEY G. SCHLADER, VICE PRESIDENT OF FINANCE
(641) 428-7349
Contract Pharmacy Representative
Mercy Medical Center - North Iowa
Suzette Rolling, Manager - Pharmacy
(641) 428-7917
Signed By Date
8/26/2011
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