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HY-VEE PHARMACY #6 (1155)
CH07055A Primary Health Care, Inc.
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Covered Entity Details
Entity Name
Primary Health Care, Inc.
Subdivision Name
Primary Health Care - Bery Engebretsen Clinic
Type
HRSA-Funded Health Center
340B ID
CH07055A
Entity Address
2353 SE 14th St
Des Moines, IA 50320-1109
Grant Number
H80CS00715
Participating Start Date
7/1/2002
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY #6 (1155)
Pharmacy Address
420 COURT AVE.
DES MOINES, IA 50309
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Huntsman, CEO
(515) 248-1441
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
10/15/2019
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