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HY-VEE PHARMACY #1192
CAH161361-00 Hamilton County Public Hospital d/b/a Van Diest Medical Center
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Covered Entity Details
Entity Name
Hamilton County Public Hospital d/b/a Van Diest Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161361-00
Entity Address
2350 Hospital Drive
Webster City, IA 50595
Medicare Provider Number
161361
Participating Start Date
4/1/2014
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY #1192
Pharmacy Address
115 SOUTH 29TH ST
FORT DODGE, IA 50501
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alice Heinrichs, CFO
(515) 832-7751
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/9/2020
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