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TRUMM DRUG ELBOW LAKE
CAH241379-00 Prairie Ridge Hospital and Health Services
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Covered Entity Details
Entity Name
Prairie Ridge Hospital and Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241379-00
Entity Address
1411 Hwy 79 East
Elbow Lake, MN 56531
Medicare Provider Number
241379
Participating Start Date
1/1/2014
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
TRUMM DRUG ELBOW LAKE
Pharmacy Address
11 CENTRAL AVE S
ELBOW LAKE, MN 56531
Pharmacy Comments
Contract Details
Approval Date
7/11/2018
Contract Begin Date
8/2/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Danielle Janice Lesmeister, Chief Executive Officer
(218) 685-7344
Contract Pharmacy Representative
Pharmacy
Allan Fettig, Pharmacist/Vice President
(320) 763-3116
Signed By Date
7/11/2018
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