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HY-VEE PHARMACY #1036
CAH261312-00 HARRISON COUNTY COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
HARRISON COUNTY COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH261312-00
Entity Address
2600 MILLER STREET
BETHANY, MO 64424
Medicare Provider Number
261312
Participating Start Date
9/28/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY #1036
Pharmacy Address
1104 S 25TH STREET
BOX 47
BETHANY, MO 64424
Pharmacy Comments
Pharmacy located at 710 main Princeton MO has the same name.
Contract Details
Approval Date
11/15/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RICHARD C. HAMILTON, ADMINISTRATOR
(660) 425-0250
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/2/2012
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