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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161341-00 Lucas County Health Center
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Covered Entity Details
Entity Name
Lucas County Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161341-00
Entity Address
1200 N 7th St
Chariton, IA 50049
Medicare Provider Number
161341
Participating Start Date
4/1/2014
Last Recertification Date
8/14/2024
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
7/16/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Sims, CEO
(641) 774-3324
Contract Pharmacy Representative
Hy-Vee Inc
Matt Pertzborn, Director, Pharm Bus Dvpt
(515) 559-5761
Signed By Date
7/16/2016
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