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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161348-00 CLARKE COUNTY PUBLIC HOSPITAL
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Covered Entity Details
Entity Name
CLARKE COUNTY PUBLIC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161348-00
Entity Address
800 S FILLMORE ST
OSCEOLA, IA 50213-1694
Medicare Provider Number
161348
Participating Start Date
9/24/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY FULFILLMENT CENTER 4016
Pharmacy Address
HY-VEE INC
4707 FLUER DR
DES MOINES, IA 50321
Pharmacy Comments
11-22-2013 Address correction
Contract Details
Approval Date
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL THILGES, CHIEF FINANCIAL OFFICER
(641) 342-5327
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/11/2019
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