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MAHASKA DRUG
CAH161367-00 PELLA REGIONAL HEALTH CENTER
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Covered Entity Details
Entity Name
PELLA REGIONAL HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161367-00
Entity Address
404 JEFFERSON ST.
PELLA, IA 50219
Medicare Provider Number
161367
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MAHASKA DRUG
Pharmacy Address
205 N E ST.
OSKALOOSA, IA 52577-2016
Pharmacy Comments
Contract Details
Approval Date
10/6/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Yvonne O'Brien-Evans, Chief Nursing Officer
(641) 628-6629
Contract Pharmacy Representative
Mahaska Drug
Jane Nicholson, President
(641) 673-3439
Signed By Date
10/6/2017
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