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HY-VEE PHARMACY (1636)
CAH161357-00 PALO ALTO COUNTY HOSPITAL
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Covered Entity Details
Entity Name
PALO ALTO COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161357-00
Entity Address
3201 FIRST STREET
EMMETSBURG, IA 50536-2516
Medicare Provider Number
161357
Participating Start Date
9/24/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1636)
Pharmacy Address
819 GRAND
SPENCER, IA 51301
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Collette Johnson, CFO
(712) 852-5402
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/14/2017
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