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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161327-00 DAVIS COUNTY HOSPITAL
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Covered Entity Details
Entity Name
DAVIS COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161327-00
Entity Address
509 N. MADISON ST.
BLOOMFIELD, IA 52537-1271
Medicare Provider Number
161327
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
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
4/21/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kendra Warning, CFO
(641) 664-7081
Contract Pharmacy Representative
Hy-Vee Inc
Matt Pertzborn, Director, Pharm Bus Dvpt
(515) 559-5761
Signed By Date
4/21/2014
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