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SHOPKO PHARMACY #2676
CAH161341-00 Lucas County Health Center
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Covered Entity Details
Entity Name
Lucas County Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161341-00
Entity Address
1200 N 7th St
Chariton, IA 50049
Medicare Provider Number
161341
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
SHOPKO PHARMACY #2676
Pharmacy Address
1901 COURT AVE
CHARITON, IA 50049
Pharmacy Comments
Contract Details
Approval Date
4/6/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Dan Minkoff, CFO
(641) 774-3275 Ext: 3275
Contract Pharmacy Representative
ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726
Signed By Date
4/6/2016
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