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HY-VEE, INC.
DSH240006 OLMSTED MEDICAL CENTER
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Covered Entity Details
Entity Name
OLMSTED MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240006
Entity Address
1650 4TH STREET SE
ROCHESTER, MN 55904
Medicare Provider Number
240006
Participating Start Date
7/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
HY-VEE, INC.
Pharmacy Address
HY-VEE HEALTHMARKET RX (7069)
136 MAIN ST SW
PRESTON, MN 55965
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin Higgins, Chief Financial Officer
(507) 529-6619
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/12/2019
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