340B Drug Pricing Program Database
PERHAM HEALTH PHARMACY
CAH241373-00 PERHAM HOSPITAL DISTRICT DBA PERHAM HEALTH - information as of 5/29/2025 2:29:36 AM
Covered Entity Details
Entity Name
PERHAM HOSPITAL DISTRICT DBA PERHAM HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241373-00
Entity Address
1000 Coney Street West
PERHAM, MN 56573
Medicare Provider Number
241373
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
PERHAM HEALTH PHARMACY
Pharmacy Address
1000 CONEY ST W
PERHAM, MN 56573-2102
Pharmacy Comments
03/16/2012 changed name and address (was East Ottertail Pharmacy 665 3rd st sw)
Contract Details
Approval Date
10/20/2011
Contract Begin Date
4/1/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chuck Hofius, CEO
(218) 346-4500
Contract Pharmacy Representative
Perham Health
Tracey Bovkoon, Director of Pharmacy
(218) 347-1571
Signed By Date
3/10/2011
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