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HY-VEE PHARMACY (1353)
CAH161355-00 KNOXVILLE COMMUNITY HOSPITAL INC.
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Covered Entity Details
Entity Name
KNOXVILLE COMMUNITY HOSPITAL INC.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161355-00
Entity Address
1002 S LINCOLN
KNOXVILLE, IA 50138
Medicare Provider Number
161355
Participating Start Date
1/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY (1353)
Pharmacy Address
809 WEST ROCK ISLAND ST
KNOXVILLE, IA 50138
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
5/10/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
4/20/2011
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