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HY-VEE PHARMACY
CAH261309-00 Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
Saint Luke's Hospital of Trenton DBA WRIGHT MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261309-00
Entity Address
191 IOWA BLVD
TRENTON, MO 64683
Medicare Provider Number
261309
Participating Start Date
9/9/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY
Pharmacy Address
HY-VEE, INC.
1617 EAST 9TH STREET
TRENTON, MO 64683
Pharmacy Comments
Contract Details
Approval Date
4/11/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/29/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gary Jordan, CEO
(660) 358-5701
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
4/11/2013
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