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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161331-00 Mercy Medical Center New Hampton
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Covered Entity Details
Entity Name
Mercy Medical Center New Hampton
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161331-00
Entity Address
308 NORTH MAPLE AVENUE
NEW HAMPTON, IA 50659
Medicare Provider Number
161331
Participating Start Date
4/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY FULFILLMENT CENTER 4016
Pharmacy Address
HY-VEE INC
4707 FLUER DR
DES MOINES, IA 50321
Pharmacy Comments
11-22-2013 Address correction
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JENNIFER RAPENSKE, REGIONAL CFO
(641) 394-1682
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/15/2020
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