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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161351-00 Avera Holy Family Health
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Covered Entity Details
Entity Name
Avera Holy Family Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161351-00
Entity Address
826 N 8TH ST
ESTHERVILLE, IA 51334
Medicare Provider Number
161351
Participating Start Date
9/30/2010
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
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
Shannon Adams, CFO
(712) 362-2631
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/14/2013
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