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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161369-00 CRAWFORD COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CRAWFORD COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161369-00
Entity Address
100 MEDICAL PARKWAY
DENISON, IA 51442-2210
Medicare Provider Number
161369
Participating Start Date
4/1/2011
Last Recertification Date
8/15/2024
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
10/29/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NANCY J. CARLSON, CHIEF FINANCIAL OFFICER
(712) 265-2505
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/15/2013
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