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HY-VEE PHARMACY FULFILLMENT CENTER 4016
SCH140089-00 MCDONOUGH DISTRICT HOSPITAL
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Covered Entity Details
Entity Name
MCDONOUGH DISTRICT HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140089-00
Entity Address
525 E. GRANT
MACOMB, IL 61455
Medicare Provider Number
140089
Participating Start Date
7/1/2017
Last Recertification Date
8/12/2024
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
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William R Murdock, President & CEO
(309) 833-4101 Ext: 13499
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
10/11/2019
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