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HY-VEE PHARMACY FULFILLMENT CENTER 4016
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 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
11/22/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
James Fairchild, CEO
(660) 425-0250 Ext: 250
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
11/22/2013
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