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HY-VEE PHARMACY FULFILLMENT CENTER 4016
CAH161357-00 PALO ALTO COUNTY HOSPITAL
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Covered Entity Details
Entity Name
PALO ALTO COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161357-00
Entity Address
3201 FIRST STREET
EMMETSBURG, IA 50536-2516
Medicare Provider Number
161357
Participating Start Date
9/24/2010
Last Recertification Date
9/4/2024
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
9/29/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Mercy Health
Collette Johnson, CFO
(712) 852-5402
Signed By Date
7/13/2017
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