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ATLANTIC MED CTR
CAH161376-00 CASS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CASS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161376-00
Entity Address
1501 EAST 10TH STREET
ATLANTIC, IA 50022
Medicare Provider Number
161376
Participating Start Date
7/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ATLANTIC MED CTR
Pharmacy Address
ATLANTIC MEDICAL CENTER PHARMACY
1501 E 10TH
PO BOX 269
ATLANTIC, IA 50022-5002
Pharmacy Comments
Contract Details
Approval Date
1/17/2012
Contract Begin Date
1/17/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Steve Lewis, ASSISTANT ADMINISTRATOR / CFO
(712) 243-7550 Ext: 3404
Contract Pharmacy Representative
Josh Borer, Owner
(712) 364-0000
Signed By Date
1/10/2012
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