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SUPERVALU PHARMACIES INC
DSH240006 OLMSTED MEDICAL CENTER
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Covered Entity Details
Entity Name
OLMSTED MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240006
Entity Address
1650 4TH STREET SE
ROCHESTER, MN 55904
Medicare Provider Number
240006
Participating Start Date
7/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
SUPERVALU PHARMACIES INC
Pharmacy Address
DBA CUB PHARMACY #1602/756
1021-15TH AVENUE SE
ROCHESTER, MN 55904
Pharmacy Comments
Contract Details
Approval Date
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Higgins, Chief Financial Officer
(507) 529-6619
Contract Pharmacy Representative
Cub Pharmacy
Aaron Sapp, Contact Person
(952) 828-4026
Signed By Date
1/16/2019
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