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RED OAK PHARMACY
CAH161363-00 Montgomery County Memorial Hospital
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Covered Entity Details
Entity Name
Montgomery County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161363-00
Entity Address
2301 Eastern Avenue
Red Oak, IA 51566
Medicare Provider Number
161363
Participating Start Date
4/1/2012
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
RED OAK PHARMACY
Pharmacy Address
FOUNTAIN SQUARE PHARMACY, INC
1400 SENATE AVE STE 104
FOUNTAIN SQ PHARMACY
RED OAK, IA 51566
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/5/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Rick J. Leinen, Chief Financial Officer
(712) 623-7150
Contract Pharmacy Representative
David Post, RPh.
(712) 623-7245
Signed By Date
4/15/2014
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