Contract Pharmacy Details

HY-VEE PHARMACY FULFILLMENT CENTER 4016
SCH160013-00 UNITY HEALTHCARE D/B/A TRINITY MUSCATINE

Covered Entity Details

Entity Name

UNITY HEALTHCARE D/B/A TRINITY MUSCATINE

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH160013-00

Entity Address

1518 MULBERRY AVE
MUSCATINE, IA 52761

Medicare Provider Number

160013

Participating Start Date

7/1/2012

Last Recertification Date

9/10/2020

Entity Termination Date

10/1/2021

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

10/13/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/24/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Dave Dellitt, Chief Financial Officer
(309) 779-2218

Contract Pharmacy Representative

Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009

Signed By Date

10/13/2016

340B Drug Pricing Program Database