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COMMUNITY PHARMACY
CAH161350-00 Stewart Memorial Community Hospital
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Covered Entity Details
Entity Name
Stewart Memorial Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161350-00
Entity Address
1301 West Main Street
Lake City, IA 51449-1585
Medicare Provider Number
161350
Participating Start Date
10/1/2011
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
COMMUNITY PHARMACY
Pharmacy Address
1321 WEST MAIN
LAKE CITY, IA 51449
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
10/1/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/23/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JAMES L. HENKENIUS, CFO
(712) 464-3171 Ext: 4200
Contract Pharmacy Representative
Stewart Memorial Community Hospital
JAMES L. HENKENIUS, CFO
(712) 464-3171 Ext: 4200
Signed By Date
9/29/2011
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