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Hy-Vee Pharmacy Fulfillment Center #4016
CAH261312-00 HARRISON COUNTY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HARRISON COUNTY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261312-00
Entity Address
2600 MILLER STREET
BETHANY, MO 64424
Medicare Provider Number
261312
Participating Start Date
9/28/2010
Last Recertification Date
8/28/2024
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
1/6/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christina Gillespie, CEO
(660) 425-2211 Ext: 2250
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
1/6/2022
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