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Hy-Vee Pharmacy Fulfillment Center #4016
SCH260186-00 Lake Regional Health System
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Covered Entity Details
Entity Name
Lake Regional Health System
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260186-00
Entity Address
54 HOSPITAL DR
Osage Beach, MO 65065-3050
Medicare Provider Number
260186
Participating Start Date
1/1/2017
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Hy-Vee Pharmacy Fulfillment Center #4016
Pharmacy Address
Hy-Vee Inc
4707 Fleur Dr
Des Moines, IA 50321
Pharmacy Comments
Contract Details
Approval Date
4/20/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Henry Zeisel, Executive Vice President Finance/CFO
(573) 348-8388
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/20/2021
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