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Hy-Vee Pharmacy Fulfillment Center #4016
CAH161327-00 DAVIS COUNTY HOSPITAL
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Covered Entity Details
Entity Name
DAVIS COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161327-00
Entity Address
509 N. MADISON ST.
BLOOMFIELD, IA 52537-1271
Medicare Provider Number
161327
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
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
10/1/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kendra Warning, CFO
(641) 664-7081
Contract Pharmacy Representative
Hy-Vee Inc
Matt Pertzborn, Director, Pharm Bus Dvpt
(515) 559-5761
Signed By Date
10/1/2021
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