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HY-VEE PHARMACY
CH07731A 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 KHS KEOKUK CLINIC
Type
HRSA-Funded Health Center
340B ID
CH07731A
Entity Address
400 N 17th St
Keokuk, IA 52632-3452
Grant Number
H80CS00272
Participating Start Date
1/1/2004
Last Recertification Date
2/9/2024
Entity Termination Date
1/1/2025
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
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
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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