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HY-VEE DRUGSTORE CLINIC PHARMACY
CAH161362-00 SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161362-00
Entity Address
300 SIOUX VALLEY DRIVE
CHEROKEE, IA 51012
Medicare Provider Number
161362
Participating Start Date
9/30/2010
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HY-VEE DRUGSTORE CLINIC PHARMACY
Pharmacy Address
321 N MAIN
MARCUS, IA 51035
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Jordan, CEO
(712) 225-2201
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
10/14/2020
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