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HY-VEE PHARMACY SOLUTIONS
CAH161351-00 Avera Holy Family Health
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Covered Entity Details
Entity Name
Avera Holy Family Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161351-00
Entity Address
826 N 8TH ST
ESTHERVILLE, IA 51334
Medicare Provider Number
161351
Participating Start Date
9/30/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY SOLUTIONS
Pharmacy Address
HYVACS, LLC
10004 S 152ND ST STE C
OMAHA, NE 68138
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
3/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shannon Adams, CFO
(712) 362-2631
Contract Pharmacy Representative
Amber Enterprises
Kelley Miller, 340B Program Manager
(402) 861-7560
Signed By Date
7/15/2019
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