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PARK NICOLLET PHARMACY #87017
CAH521345-00 Westfields Hospital
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Covered Entity Details
Entity Name
Westfields Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521345-00
Entity Address
535 Hospital Road
New Richmond, WI 54017
Medicare Provider Number
521345
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
PARK NICOLLET PHARMACY #87017
Pharmacy Address
3800 PARK NICOLLET BLVD STE 1170
ST LOUIS PARK, MN 55416-2527
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Luhrs, Chief Financial Officer
(715) 243-2852
Contract Pharmacy Representative
HealthPartners
David L. Busch, VP of Pharmacy Operations
(952) 967-5049
Signed By Date
1/15/2019
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