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HY-VEE CLINIC PHARMACY #1036
CAH261309-00 Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261309-00
Entity Address
191 IOWA BLVD
TRENTON, MO 64683
Medicare Provider Number
261309
Participating Start Date
9/9/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HY-VEE CLINIC PHARMACY #1036
Pharmacy Address
710 W MAIN
PRINCETON, MO 64673
Pharmacy Comments
Pharmacy at 1104 South 25th Street Bethany MO has the same name.
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JANET BUCKMAN, CHIEF FINANCIAL OFFICER
(660) 214-8106
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/2/2020
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