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Hy-Vee Pharmacy Fulfillment Center #4016
CAH161379-00 Mahaska County Hospital d/b/a Mahaska Health Partnership
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Covered Entity Details
Entity Name
Mahaska County Hospital d/b/a Mahaska Health Partnership
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161379-00
Entity Address
1229 C Avenue East
Oskaloosa, IA 52577
Medicare Provider Number
161379
Participating Start Date
7/1/2012
Last Recertification Date
8/14/2024
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
4/7/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/20/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrea Hagist, CNO
(641) 672-3140
Contract Pharmacy Representative
Mahaska Health Partnership
Kirsten Dougherty, Director of Pharmacy
(641) 672-3373
Signed By Date
4/7/2022
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