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Hy-Vee Pharmacy Fulfillment Center #4016
DSH140015 BLESSING HOSPITAL
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Covered Entity Details
Entity Name
BLESSING HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140015
Entity Address
1005 BROADWAY
QUINCY, IL 62301
Medicare Provider Number
140015
Participating Start Date
4/1/2025
Last Recertification Date
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
1/27/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Duplicate contract pharmacy record
Contacts
Covered Entity Signing Official
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
1/7/2025
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