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HY-VEE PHARMACY (1044)
CH077310 COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Subdivision Name
CHC/SEIA WEST BURLINGTON CLINIC
Type
HRSA-Funded Health Center
340B ID
CH077310
Entity Address
1706 W Agency Rd
West Burlington, IA 52655-1667
Grant Number
H80CS00272
Participating Start Date
1/1/2003
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1044)
Pharmacy Address
3140 AGENCY
BURLINGTON, IA 52601
Pharmacy Comments
Contract Details
Approval Date
7/1/2003
Contract Begin Date
7/1/2003
Carve-In Effective Date
Contract Comments
11/27/2009- UPDATED AUTHORIZING OFFICIAL AND CONTACT PERSON INFORMATION FOR BOTH CE AND PHARMACY; 5/9/2008-UPDATED THE PHARMACY ADD. AT REQUEST OF COVERED ENTITY (WAS 3150 AGENCY ST)
Contacts
Covered Entity Signing Official
RONALD KEMP, CEO
(319) 753-2300 Ext: 100
Contract Pharmacy Representative
Signed By Date
6/27/2008
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