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THRIFTY WHITE PHARMACY #792
CAH241340-00 NORTHERN PINES MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHERN PINES MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241340-00
Entity Address
5211 HIGHWAY 110
AURORA, MN 55705
Medicare Provider Number
241340
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #792
Pharmacy Address
221 KENNEDY MEMORIAL DR.
SUITE A
HOYT LAKES, MN 55750-1141
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laura Ackman, President
(218) 229-2211 Ext: 4222
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
4/15/2019
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