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HY-VEE PHARMACY FULFILLMENT CENTER 4016
SCH160080-00 Mercy Medical Center
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Covered Entity Details
Entity Name
Mercy Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH160080-00
Entity Address
1410 North 4th St
Clinton, IA 52732
Medicare Provider Number
160080
Participating Start Date
10/1/2014
Last Recertification Date
8/31/2019
Entity Termination Date
4/1/2020
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
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Amy E Berentes, EVP/Chief Operating Officer
(563) 244-5608
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
10/15/2019
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