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HY-VEE PHARMACY (1820)
CAH431336-00 SANFORD VERMILLION MEDICAL CENTER
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Covered Entity Details
Entity Name
SANFORD VERMILLION MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431336-00
Entity Address
20 S. PLUM ST
VERMILLION, SD 57069
Medicare Provider Number
431336
Participating Start Date
9/1/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1820)
Pharmacy Address
525 W CHERRY ST
VERMILLION, SD 57069
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stan Knobloch, Director of Finance
(712) 472-6143
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/8/2020
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