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HY-VEE, INC.
DSH160083 CATHOLIC HEALTH INITIATIVES - IOWA, CORP
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Covered Entity Details
Entity Name
CATHOLIC HEALTH INITIATIVES - IOWA, CORP
Subdivision Name
MERCYONE DES MOINES MEDICAL CENTER
Type
Disproportionate Share Hospital
340B ID
DSH160083
Entity Address
1111 6th Avenue
DES MOINES, IA 50314-2610
Medicare Provider Number
160083
Participating Start Date
4/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
HY-VEE, INC.
Pharmacy Address
DBA: HY-VEE PHARMACY #2 (1023)
2510 SW STATE ST.
ANKENY, IA 50023
Pharmacy Comments
01/15/2014 Pharmacy number and address correction, locations merged, see history for details
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randall Rubin, Senior Vice President Chief Financial Officer
(515) 643-2860
Contract Pharmacy Representative
Catholic Health Initiatives, Iowa Corp
Candace Marie Jordan, Mkt Director of Pharmacy
(515) 247-3262
Signed By Date
7/15/2020
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