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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH261321-00 Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center
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Covered Entity Details
Entity Name
Saint Luke's Hospital of Chillicothe DBA Hedrick Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261321-00
Entity Address
2799 N Washington
CHILLICOTHE, MO 64601
Medicare Provider Number
261321
Participating Start Date
9/7/2010
Last Recertification Date
8/21/2024
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
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JANET BUCKMAN, CHIEF FINANCIAL OFFICER
(660) 214-8106
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/11/2019
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