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PHARMACISTS ASSOCIATES LLC
CAH351312-00 NORTHWOOD DEACONESS HEALTH CENTER
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Covered Entity Details
Entity Name
NORTHWOOD DEACONESS HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351312-00
Entity Address
4 N PARK STREET
NORTHWOOD, ND 58267
Medicare Provider Number
351312
Participating Start Date
4/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PHARMACISTS ASSOCIATES LLC
Pharmacy Address
DBA COOPERSTOWN DRUG
901 BURREL AVE SE, PO BOX 627
COOPERSTOWN, ND 58425-0627
Pharmacy Comments
Contract Details
Approval Date
10/4/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pete Antonson, CFO
(701) 587-6459
Contract Pharmacy Representative
Pharmacists Associates LLC
Shane Wendel, Pharmacist
(701) 652-5810
Signed By Date
10/4/2018
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