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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161326-00 MADISON COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MADISON COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161326-00
Entity Address
300 W. HUTCHINGS STREET
WINTERSET, IA 50273
Medicare Provider Number
161326
Participating Start Date
9/1/2010
Last Recertification Date
9/4/2024
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
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARCIA HENDRICKS, CEO
(515) 462-2373 Ext: 609
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
1/17/2017
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