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Hy-Vee Pharmacy Fulfillment Center #4016
CAH161353-00 Kossuth Regional Health Center
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Covered Entity Details
Entity Name
Kossuth Regional Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161353-00
Entity Address
1515 South Phillips Street
Algona, IA 50511
Medicare Provider Number
161353
Participating Start Date
10/1/2012
Last Recertification Date
8/16/2024
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ryan Warnke, CFO
(515) 295-4508
Contract Pharmacy Representative
Hy-Vee
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
10/14/2019
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