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HY-VEE PHARMACY (1634)
CAH161375-00 BUENA VISTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
BUENA VISTA REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161375-00
Entity Address
1525 W. 5TH ST.
STORM LAKE, IA 50588
Medicare Provider Number
161375
Participating Start Date
8/18/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1634)
Pharmacy Address
1250 N LAKE AVENUE
STORM LAKE, IA 50588
Pharmacy Comments
2/2/10 UPDATED ADD (WAS 606 LAKE AVE)
Contract Details
Approval Date
5/21/2012
Contract Begin Date
5/21/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Krista L. Ketcham, Chief Financial Officer
(712) 213-8603
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
5/11/2012
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