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THRIFTY WHITE DRUG #756
CAH241336-00 KITTSON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KITTSON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241336-00
Entity Address
1010 S BIRCH AVE
HALLOCK, MN 56728
Medicare Provider Number
241336
Participating Start Date
4/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE DRUG #756
Pharmacy Address
101 CLEVELAND AVE E
P.O. BOX 197
KARLSTAD, MN 56732-4512
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeni Schwenzfeier, Chief Financial Officer
(218) 843-3612
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
7/11/2019
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