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LEWIS FAMILY DRUG #69
CAH161336-00 Hegg Memorial Hospital
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Covered Entity Details
Entity Name
Hegg Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161336-00
Entity Address
1202 21st Ave
Rock Valley, IA 51247
Medicare Provider Number
161336
Participating Start Date
10/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
LEWIS FAMILY DRUG #69
Pharmacy Address
1227 VALLEY DR
ROCK VALLEY, IA 51247-1552
Pharmacy Comments
Contract Details
Approval Date
5/29/2012
Contract Begin Date
5/29/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Glenn Zevenbergen, CEO
(712) 476-8009
Contract Pharmacy Representative
Lewis Drug
Scott Cross, EVP
(605) 367-2800
Signed By Date
5/8/2012
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