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HY-VEE, INC.
CAH161349-00 Virginia Gay Hospital
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Covered Entity Details
Entity Name
Virginia Gay Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161349-00
Entity Address
502 N 9th Ave
Vinton, IA 52349
Medicare Provider Number
161349
Participating Start Date
4/1/2012
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HY-VEE, INC.
Pharmacy Address
HY-VEE DOLLAR FRESH
911 S K AVE
VINTON, IA 52349-1073
Pharmacy Comments
Contract Details
Approval Date
6/18/2020
Contract Begin Date
6/18/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly Jean Henkle, Director of General Services
(319) 472-6379
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
6/18/2020
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