340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HY-VEE PHARMACY FULFILLMENT CENTER 4016
DSH160057AA Southeast Iowa Regional Medical Center
Print
Covered Entity Details
Entity Name
Southeast Iowa Regional Medical Center
Subdivision Name
MENTAL HEALTH-SOUTHEAST IOWA REGION - Mental Health
Type
Disproportionate Share Hospital
340B ID
DSH160057AA
Entity Address
1225 S GEAR AVE
STE 251
WEST BURLINGTON, IA 52655-1688
Medicare Provider Number
160057
Outpatient Facility Provider Number
Participating Start Date
4/1/2022
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY FULFILLMENT CENTER 4016
Pharmacy Address
HY-VEE INC
4707 FLUER DR
DES MOINES, IA 50321
Pharmacy Comments
11-22-2013 Address correction
Contract Details
Approval Date
2/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
CE terminated due to audit finding
Contacts
Covered Entity Signing Official
Jeremy Alexander, CFO
(319) 768-3280
Contract Pharmacy Representative
Southeast Iowa Regional Medical Center
Steve Frigo, Director, Pharmacy
(319) 768-3971
Signed By Date
2/18/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session