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HY-VEE PHARMACY
CAH161302-00 IOWA SPECIALTY HOSPITAL - CLARION
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Covered Entity Details
Entity Name
IOWA SPECIALTY HOSPITAL - CLARION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161302-00
Entity Address
1316 S Main St
CLARION, IA 50525
Medicare Provider Number
161302
Participating Start Date
9/14/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY
Pharmacy Address
611 10TH AVE. N.
HUMBOLDT, IA 50548
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GREG POLZIN, CFO
(641) 444-5623
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
4/17/2023
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