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HY-VEE, INC.
CAH281349-00 PENDER COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PENDER COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281349-00
Entity Address
100 HOSPITAL DR
PENDER, NE 68047-0100
Medicare Provider Number
281349
Participating Start Date
1/1/2011
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
HY-VEE, INC.
Pharmacy Address
HY-VEE PHARMACY (7090)
500 PLAZA DR.
WEST POINT, NE 68788-2612
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Melissa Kelly, CFO/COO
(402) 385-4012
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
7/15/2019
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