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MEDICAP PHARMACY
SCH160001-00 UNITYPOINT HEALTH-MARSHALLTOWN
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Covered Entity Details
Entity Name
UNITYPOINT HEALTH-MARSHALLTOWN
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160001-00
Entity Address
3 SOUTH 4TH AVENUE
MARSHALLTOWN, IA 50158
Medicare Provider Number
160001
Participating Start Date
1/1/2019
Last Recertification Date
9/3/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
TAZ PHARMACIES LLP
11 N. 3RD AVE.
PO BOX 696
MARSHALLTOWN, IA 50158
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Hilary Dolbee, CFO
(641) 754-5125
Contract Pharmacy Representative
Sam Zoske, Owner
(641) 752-7139
Signed By Date
1/13/2014
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