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AMANA SOCIETY PHARMACY
CAH161317-00 Marengo Memorial Hospital d/b/a Compass Memorial Healthcare
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Covered Entity Details
Entity Name
Marengo Memorial Hospital d/b/a Compass Memorial Healthcare
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161317-00
Entity Address
300 West May Street
Marengo, IA 52301
Medicare Provider Number
161317
Participating Start Date
1/1/2012
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
AMANA SOCIETY PHARMACY
Pharmacy Address
507-39TH AVE
PO BOX 206
AMANA, IA 52203-0206
Pharmacy Comments
Contract Details
Approval Date
10/15/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/28/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mikaela Gehring, Chief Operating Officer
(319) 642-8045
Contract Pharmacy Representative
Tom Stumpff, Owner/Pharmacist
(319) 622-3341
Signed By Date
10/15/2013
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