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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161364-00 JEFFERSON COUNTY HEALTH CENTER
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Covered Entity Details
Entity Name
JEFFERSON COUNTY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161364-00
Entity Address
2000 SOUTH MAIN STREET
FAIRFIELD, IA 52556
Medicare Provider Number
161364
Participating Start Date
8/24/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY FULFILLMENT CENTER 4016
Pharmacy Address
HY-VEE INC
4707 FLUER DR
DES MOINES, IA 50321
Pharmacy Comments
11-22-2013 Address correction
Contract Details
Approval Date
4/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRYAN HUNGER, CEO
(641) 469-4303
Contract Pharmacy Representative
Hy-Vee
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
4/4/2017
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