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HY-VEE, INC.
CAH241359-00 AVERA MARSHALL
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Covered Entity Details
Entity Name
AVERA MARSHALL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241359-00
Entity Address
300 S BRUCE STREET
MARSHALL, MN 56258-1934
Medicare Provider Number
241359
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
HY-VEE, INC.
Pharmacy Address
HY-VEE CLINIC PHARMACY (1400)
1420 E COLLEGE DR.
MARSHALL, MN 56258
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
9/12/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/14/2015
Pharmacy closed
Contacts
Covered Entity Signing Official
SHARON WILLIAMS, VP OF FINANCE AND IT
(507) 537-9150
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
8/4/2011
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