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AMBER ENTERPRISES, INC
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
AMBER ENTERPRISES, INC
Pharmacy Address
DBA AMBER SPECIALTY PHARMACY
1 E ERIE ST STE 630
CHICAGO, IL 60611
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dawnett Willis, Chief Ancillary Services Officer
(641) 621-2480
Contract Pharmacy Representative
Amber Enterprises
Kelley Miller, 340B Program Manager
(402) 861-7560
Signed By Date
4/13/2018
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