340B Drug Pricing Program Database

Pharmacy Name

HY-VEE PHRM CLINIC 1504

Pharmacy Address

301 W. JEFFERSON
BLOOMFIELD, IA 52537

Pharmacy Comments

Approval Date

3/11/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Deborah L. Herzberg, Chief Executive Officer
(641) 664-2145

Contract Pharmacy Representative

Robert G. Egeland, Vice President of Pharmacy
(515) 453-2784

Signed By Date

1/25/2013