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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161334-00 Humboldt County Memorial Hospital
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Covered Entity Details
Entity Name
Humboldt County Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161334-00
Entity Address
1000 North 15th Street
Humboldt, IA 50548
Medicare Provider Number
161334
Participating Start Date
10/1/2012
Last Recertification Date
8/19/2024
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
Contract Termination Date
Termination Reason
3/23/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jim Atty, CEO
(515) 332-4200
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/15/2013
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