340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
LINDSTROM THRIFTY WHITE PHARMACY
CAH521337-05 ST. CROIX REGIONAL MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ST. CROIX REGIONAL MEDICAL CENTER
Subdivision Name
Unity Clinic
Type
Critical Access Hospital
340B ID
CAH521337-05
Entity Address
1504 190th Avenue
Balsam Lake, WI 54810
Medicare Provider Number
521337
Outpatient Facility Provider Number
528605
Participating Start Date
4/1/2013
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
LINDSTROM THRIFTY WHITE PHARMACY
Pharmacy Address
30699 LINCOLN RD
LINDSTROM, MN 55045-8083
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sally Bajak, CFO
(715) 483-0556
Contract Pharmacy Representative
Lindstrom Thrifty White Pharmacy
Matthew Garrison, PIC, Pharm D
(651) 257-4074
Signed By Date
1/7/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session