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HY-VEE PHARMACY
CH077310 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA WEST BURLINGTON CLINIC
Type
HRSA-Funded Health Center
340B ID
CH077310
Entity Address
1706 W Agency Rd
West Burlington, IA 52655-1667
Grant Number
H80CS00272
Participating Start Date
1/1/2003
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY
Pharmacy Address
3111 MAIN
KEOKUK, IA 52632
Pharmacy Comments
Contract Details
Approval Date
7/13/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RONALD KEMP, CEO
(319) 753-2300 Ext: 100
Contract Pharmacy Representative
Hy-Vee
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
7/13/2018
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