Contract Pharmacy Details

UNION DRUG
CAH161316-00 Palmer Lutheran Health Center

Covered Entity Details

Entity Name

Palmer Lutheran Health Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH161316-00

Entity Address

112 Jefferson Street
West Union, IA 52175

Medicare Provider Number

161316

Participating Start Date

4/1/2012

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

UNION DRUG

Pharmacy Address

315 HWY 150N
WEST UNION, IA 52175-1048

Pharmacy Comments

Contract Details

Approval Date

10/14/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/2/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Joni Gisleson, CFO
(563) 422-3811 Ext: 1702

Contract Pharmacy Representative

Steve Metcalf, Pharmacist
(563) 422-3721

Signed By Date

10/14/2013