340B Drug Pricing Program Database

Pharmacy Name

HY-VEE FOOD STORES #1610

Pharmacy Address

2827 HAMILTON BLVD
SIOUX CITY, IA 51104

Pharmacy Comments

Approval Date

2/22/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

MICHELLE STEPHAN, CEO
(712) 202-1011

Contract Pharmacy Representative

Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800

Signed By Date

1/14/2013