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PRAIRIE PHARMACY
CAH241326-00 CENTRACARE HEALTH SYSTEM-LONG PRAIRIE
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Covered Entity Details
Entity Name
CENTRACARE HEALTH SYSTEM-LONG PRAIRIE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241326-00
Entity Address
50 CentraCare Drive
LONG PRAIRIE, MN 56347
Medicare Provider Number
241326
Participating Start Date
9/29/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
PRAIRIE PHARMACY
Pharmacy Address
244 CENTRAL AVE
LONG PRAIRIE, MN 56347
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2021
Ownership change
Contacts
Covered Entity Signing Official
DANIEL SWENSON, ADMINSTRATOR/CEO
(320) 732-7210
Contract Pharmacy Representative
Prairie Pharmacy
Jeff Sawyer, Pharmacist
(320) 256-7292
Signed By Date
7/12/2018
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