340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
Hy-Vee Pharmacy Fulfillment Center #4016
DSH160110 Allen Memorial Hospital Corporation
Print
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 Fulfillment Center #4016
Pharmacy Address
Hy-Vee Inc
4707 Fleur Dr
Des Moines, IA 50321
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
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