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HY-VEE PHARMACY FULFILLMENT CENTER 4016
SCH260050-00 Mosaic Medical Center Maryville
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Covered Entity Details
Entity Name
Mosaic Medical Center Maryville
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH260050-00
Entity Address
2016 S. Main
Maryville, MO 64468
Medicare Provider Number
260050
Participating Start Date
10/1/2013
Last Recertification Date
8/19/2024
Entity Termination Date
4/1/2025
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
10/7/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Baumgartner, President
(660) 562-7900
Contract Pharmacy Representative
Hy- Vee
BOB EGELAND, VP PHARMACY OPERATIONS
(515) 267-2800
Signed By Date
10/7/2016
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