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ALTRU HEALTH SYSTEM
SCH350019-00 ALTRU HOSPITAL
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Covered Entity Details
Entity Name
ALTRU HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH350019-00
Entity Address
1200 SOUTH COLUMBIA ROAD
GRAND FORKS, ND 58201
Medicare Provider Number
350019
Participating Start Date
8/5/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
ALTRU HEALTH SYSTEM
Pharmacy Address
1200 S COLUMBIA RD
GRAND FORKS, ND 58201
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Jerry Berge, Director of Finance
(701) 780-5542
Contract Pharmacy Representative
Altru Health System
Erin Gail Navarro, Director of Pharmacy
(701) 780-3443
Signed By Date
7/17/2018
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