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HY-VEE MAINSTREET PHARMACY #7070
DSH160146 ST. LUKE'S REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160146
Entity Address
2720 STONE PARK BLVD
SIOUX CITY, IA 51104
Medicare Provider Number
160146
Participating Start Date
1/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
HY-VEE MAINSTREET PHARMACY #7070
Pharmacy Address
2611 PIERCE ST
SIOUX CITY, IA 51104
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Wendy L Lindley, Chief Nursing Executive
(712) 279-3394
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
1/15/2025
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