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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161366-00 Shenandoah Medical Center
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Covered Entity Details
Entity Name
Shenandoah Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161366-00
Entity Address
300 Pershing Ave
Shenandoah, IA 51601-2355
Medicare Provider Number
161366
Participating Start Date
10/1/2011
Last Recertification Date
9/3/2024
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
Contacts
Covered Entity Signing Official
Matthew Richard Sells, President and CEO
(712) 246-7160
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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