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HY-VEE PHARMACY (1295)
CAH161380-00 ELLSWORTH MUNICIPAL HOSPITAL
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Covered Entity Details
Entity Name
ELLSWORTH MUNICIPAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161380-00
Entity Address
920 S OAK ST
DBA HANSEN FAMILY HOSPITAL
IOWA FALLS, IA 50126-9506
Medicare Provider Number
161380
Participating Start Date
9/1/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1295)
Pharmacy Address
632 S. OAK RIVER HILLS
IOWA FALLS, IA 50126
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RUTH ANN STEIG, ACCOUNTANT
(641) 648-7047
Contract Pharmacy Representative
Marshall Sanders, AVP-Retail Pharmacy
(515) 267-6009
Signed By Date
4/17/2017
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