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HY-VEE PHARMACY SOLUTIONS
DSH160067 MercyOne Waterloo Medical Center
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Covered Entity Details
Entity Name
MercyOne Waterloo Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160067
Entity Address
3421 W 9TH STREET
WATERLOO, IA 50702
Medicare Provider Number
160067
Participating Start Date
1/1/2011
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
HY-VEE PHARMACY SOLUTIONS
Pharmacy Address
HYVACS, LLC
10004 S 152ND ST STE C
OMAHA, NE 68138
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Huber, Vice President of Finance
(319) 272-7607
Contract Pharmacy Representative
Amber Pharmacy
Joseph Acierno, VP Compliance; Privacy and HIPPA Officer
(888) 370-1724 Ext: 4929
Signed By Date
7/17/2017
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