340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HY-VEE PHARMACY #1 (1504)
CAH161377-00 MercyOne Centerville Medical Center
Print
Covered Entity Details
Entity Name
MercyOne Centerville Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161377-00
Entity Address
ONE ST. JOSEPH'S DRIVE
CENTERVILLE, IA 52544
Medicare Provider Number
161377
Participating Start Date
7/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY #1 (1504)
Pharmacy Address
1025 N. QUINCY
OTTUMWA, IA 52501
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
MATTHEW DONALD JOHNSON, President
(641) 437-3411
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/9/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session