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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161346-00 SIOUX CENTER HEALTH
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Covered Entity Details
Entity Name
SIOUX CENTER HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161346-00
Entity Address
1101 9th St SE
SIOUX CENTER, IA 51250-1398
Medicare Provider Number
161346
Participating Start Date
9/28/2010
Last Recertification Date
8/16/2024
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
12/2/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/16/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KAYLEEN LEE, CHIEF EXECUTIVE OFFICER
(712) 722-8107
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/13/2013
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