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Hy-Vee Pharmacy Fulfillment Center #4016
CAH281322-00 FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE
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Covered Entity Details
Entity Name
FRANCISCAN CARE SERVICES INC DBA FRANCISCAN HEALTHCARE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281322-00
Entity Address
430 NORTH MONITOR STREET
WEST POINT, NE 68788
Medicare Provider Number
281322
Participating Start Date
7/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
Hy-Vee Pharmacy Fulfillment Center #4016
Pharmacy Address
Hy-Vee Inc
4707 Fleur Dr
Des Moines, IA 50321
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
7/10/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jerry Wordekemper, CEO/PRESIDENT
(402) 372-2404 Ext: 2101
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
7/10/2019
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