Contract Pharmacy Details

CENTRACARE PHARMACY HEALTH
CAH241362-00 CENTRACARE HEALTH-MONTICELLO

Covered Entity Details

Entity Name

CENTRACARE HEALTH-MONTICELLO

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH241362-00

Entity Address

1013 HART BLVD.
MONTICELLO, MN 55362-8575

Medicare Provider Number

241362

Participating Start Date

9/8/2010

Last Recertification Date

9/10/2024

Pharmacy Details

Pharmacy Name

CENTRACARE PHARMACY HEALTH

Pharmacy Address

PLAZA
1900 CENTRACARE CIR
SUITE 1350
SAINT CLOUD, MN 56303-5000

Pharmacy Comments

Contract Details

Approval Date

10/9/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jason Philip Weaver, Divsion Director of Finance
(763) 271-2842

Contract Pharmacy Representative

CentraCare
Keith Karsky, Coordinator, Retail Pharmacy Services
(320) 229-5199 Ext: 70580

Signed By Date

10/9/2019

340B Drug Pricing Program Database