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HUGO'S FAMILY PHARMACY
SCH350019-00 ALTRU HOSPITAL
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Covered Entity Details
Entity Name
ALTRU HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH350019-00
Entity Address
1200 SOUTH COLUMBIA ROAD
GRAND FORKS, ND 58201
Medicare Provider Number
350019
Participating Start Date
8/5/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
HUGO'S FAMILY PHARMACY
Pharmacy Address
224 14TH ST NE
EAST GRAND FORKS, MN 56721-1628
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Janice Hamscher, Chief Nursing Officer
(701) 780-3403
Contract Pharmacy Representative
Hugo's Family Pharmacy
SEAN KARPOWICH, DIRECTOR OF PHARMACY
(218) 773-0611
Signed By Date
4/12/2019
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