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DBA NUCARA PHARMACY #16
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
DBA NUCARA PHARMACY #16
Pharmacy Address
107 W MAIN ST STE A
OTTUMWA, IA 52501-2542
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Yvonne O'Brien-Evans, Chief Nursing Officer
(641) 628-6629
Contract Pharmacy Representative
Nucara
Jon Caston, Pharmacy Manager
(641) 684-5453
Signed By Date
10/16/2017
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