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WHITE DRUG #52
CAH161328-00 REGIONAL HEALTH SERVICES OF HOWARD COUNTY
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Covered Entity Details
Entity Name
REGIONAL HEALTH SERVICES OF HOWARD COUNTY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161328-00
Entity Address
235 8TH AVENUE WEST
CRESCO, IA 52136
Medicare Provider Number
161328
Participating Start Date
9/13/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WHITE DRUG #52
Pharmacy Address
706 38TH ST N STE B
FARGO, ND 58102-2953
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
Gregory J. Burkel, EXECUTIVE FINANCE OFFICER
(641) 732-6070
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
10/4/2018
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