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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161362-00 SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
SIOUX VALLEY MEMORIAL HOSPITAL ASSOCIATION D/B/A CHEROKEE REGIONAL MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161362-00
Entity Address
300 SIOUX VALLEY DRIVE
CHEROKEE, IA 51012
Medicare Provider Number
161362
Participating Start Date
9/30/2010
Last Recertification Date
8/14/2024
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
4/28/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOHN M. COMSTOCK, CEO
(712) 225-1505
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
4/28/2014
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