Contract Pharmacy Details

HY-VEE, INC.
CH071243B Infinity Health

Covered Entity Details

Entity Name

Infinity Health

Subdivision Name

Infinity Health - Lamoni Office

Type

HRSA-Funded Health Center

340B ID

CH071243B

Entity Address

802 Ackerly St
Lamoni, IA 50140-1544

Grant Number

H80CS04200

Participating Start Date

9/9/2005

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

HY-VEE, INC.

Pharmacy Address

DBA: HY-VEE CLINIC PHARMACY (1376)
101 E MAIN
LAMONI, IA 50140

Pharmacy Comments

Contract Details

Approval Date

4/14/2014

Contract Begin Date

4/14/2014

Carve-In Effective Date

Contract Comments

04/14/2014 Contract begin date adjustment, immediate begin date authorized

Contacts

Covered Entity Signing Official

Samantha Cannon, Chief Executive Officer
(641) 446-2383 Ext: 1250

Contract Pharmacy Representative

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

Signed By Date

4/14/2014

340B Drug Pricing Program Database