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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161348-00 CLARKE COUNTY PUBLIC HOSPITAL
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Covered Entity Details
Entity Name
CLARKE COUNTY PUBLIC HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161348-00
Entity Address
800 S FILLMORE ST
OSCEOLA, IA 50213-1694
Medicare Provider Number
161348
Participating Start Date
9/24/2010
Last Recertification Date
8/13/2024
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
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/1/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MICHAEL THILGES, CHIEF FINANCIAL OFFICER
(641) 342-5327
Contract Pharmacy Representative
Hy-Vee Inc
Matt Pertzborn, Director, Pharm Bus Dvpt
(515) 559-5761
Signed By Date
10/13/2016
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