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Hy-Vee Pharmacy Fullfillment Center #4016
CH072130 NORTHWEST HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
NORTHWEST HEALTH SERVICES, INC.
Subdivision Name
FAMILY MEDICINE ASSOCIATES
Type
HRSA-Funded Health Center
340B ID
CH072130
Entity Address
2303 Village Dr
Saint Joseph, MO 64506-4954
Grant Number
H80CS00671
Participating Start Date
10/1/1997
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
Hy-Vee Pharmacy Fullfillment Center #4016
Pharmacy Address
Hy-Vee Inc
4704 Fleur Dr
Des Moines, IA 50321
Pharmacy Comments
Contract Details
Approval Date
7/13/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/7/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Deanna Lamb, CEO
(816) 271-8201
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
7/13/2017
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