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HY-VEE PHARMACY FULFILLMENT CENTER 4016
SCH140001-00 GRAHAM HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
GRAHAM HOSPITAL ASSOCIATION
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140001-00
Entity Address
210 W. Walnut Street
Canton, IL 61520
Medicare Provider Number
140001
Participating Start Date
7/1/2015
Last Recertification Date
8/26/2024
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
10/24/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Franz, Chief Financial Officer
(309) 647-5240 Ext: 2500
Contract Pharmacy Representative
Hy-Vee, Inc
Ashley Plum, 340B Coordinator
(515) 559-5708
Signed By Date
10/24/2016
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