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HARTIG DRUG COMPANY
CAH161312-03 GUTTENBERG MUNICIPAL HOSPITAL
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Covered Entity Details
Entity Name
GUTTENBERG MUNICIPAL HOSPITAL
Subdivision Name
Cornerstone Family Practice
Type
Critical Access Hospital
340B ID
CAH161312-03
Entity Address
101 S. Washington
Edgewood, IA 52042-8512
Medicare Provider Number
161312
Outpatient Facility Provider Number
168553
Participating Start Date
1/1/2019
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HARTIG DRUG COMPANY
Pharmacy Address
STONE CREEK SHOPPING CENTER
711 16TH AVE SE
DYERSVILLE, IA 52040
Pharmacy Comments
Contract Details
Approval Date
7/10/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kimberley A. Gau, CEO
(563) 252-1121 Ext: 2330
Contract Pharmacy Representative
Keith Bibelhausen, President
(563) 588-8700 Ext: 10030
Signed By Date
7/10/2017
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