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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161376-00 CASS COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CASS COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161376-00
Entity Address
1501 EAST 10TH STREET
ATLANTIC, IA 50022
Medicare Provider Number
161376
Participating Start Date
7/1/2011
Last Recertification Date
9/5/2024
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
4/16/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/28/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
STEVE LEWIS, ASSISTANT ADMINISTRATOR / CFO
(712) 243-7550 Ext: 3404
Contract Pharmacy Representative
Hy-Vee Inc
Matt Pertzborn, Director, Pharm Bus Dvpt
(515) 559-5761
Signed By Date
4/16/2014
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