340B Drug Pricing Program Database
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CAH241325-01 CCM Health (Terminated)
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Main Details
Name
CCM Health
Subdivision Name
Montevideo Medical Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241325-01
Medicare Provider Number
241325
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/3/2013
Last Recertification Date
8/16/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
CCM Health
Brian Lovdahl, CEO
(320) 321-8101
Primary Contact
CCM Health
Jamie L Malstrom, Director of Pharmacy
(320) 321-8175
Addresses
Street Address
824 North 11th Street
Montevideo, MN 56265
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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