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Hy-Vee Pharmacy Fullfillment Center #4016
CAH161356-00 HENRY COUNTY HEALTH CENTER INC
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Covered Entity Details
Entity Name
HENRY COUNTY HEALTH CENTER INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161356-00
Entity Address
407 SOUTH WHITE STREET
MOUNT PLEASANT, IA 52641-2242
Medicare Provider Number
161356
Participating Start Date
7/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
Hy-Vee Pharmacy Fullfillment Center #4016
Pharmacy Address
Hy-Vee Inc
4704 Fleur Dr
Des Moines, IA 50321
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID MUHS, CHIEF FINANCIAL OFFICER
(319) 385-6716
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
1/13/2020
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