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HY VEE PHARMACY
DSH160110 Allen Memorial Hospital Corporation
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Covered Entity Details
Entity Name
Allen Memorial Hospital Corporation
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160110
Entity Address
1825 Logan Avenue
Waterloo, IA 50703-1916
Medicare Provider Number
160110
Participating Start Date
1/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
HY VEE PHARMACY
Pharmacy Address
1422 FLAMMANG
WATERLOO, IA 50702
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer A Friedly, President
(319) 235-3997
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
7/15/2024
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