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HY-VEE PHARMACY SOLUTIONS
SCH160005-00 ST. ANTHONY REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
ST. ANTHONY REGIONAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160005-00
Entity Address
311 SOUTH CLARK STREET
CARROLL, IA 51401
Medicare Provider Number
160005
Participating Start Date
10/1/2017
Last Recertification Date
9/12/2023
Entity Termination Date
5/22/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY SOLUTIONS
Pharmacy Address
HYVACS, LLC
10004 S. 152ND ST., SUITE C
OMAHA, NE 68138
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Munson, Vice President & CFO
(712) 794-5115
Contract Pharmacy Representative
Amber Enterprises
Kelley Miller, 340B Program Manager
(402) 861-7560
Signed By Date
1/11/2019
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