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PROMISE PHARMACY LLC
CH050320 COMMUNITY HEALTH SERVICE INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH SERVICE INC.
Subdivision Name
Community Health Service Inc. Moorhead
Type
HRSA-Funded Health Center
340B ID
CH050320
Entity Address
2310 4th Ave N
Moorhead, MN 56560
Grant Number
H80CS00660
Participating Start Date
7/1/1999
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
PROMISE PHARMACY LLC
Pharmacy Address
OUT BACK STEAKHOUSE PLAZA
31818 US HIGHWAY 19 N
PALM HARBOR, FL 34684-3713
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristi Halvarson, Executive Director
(218) 422-7431
Contract Pharmacy Representative
Promise Pharmacy
Alex Grant, Pharmacy POC
(908) 420-5524
Signed By Date
10/15/2018
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