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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161339-00 WAVERLY HEALTH CENTER
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Covered Entity Details
Entity Name
WAVERLY HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161339-00
Entity Address
312 9TH ST SW
WAVERLY, IA 50677
Medicare Provider Number
161339
Participating Start Date
9/1/2010
Last Recertification Date
8/15/2024
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
10/29/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kyle Richards, CEO
(319) 352-4941
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/15/2013
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