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VILAS
CAH431301-00 Faulkton Area Medical Center
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Covered Entity Details
Entity Name
Faulkton Area Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431301-00
Entity Address
1300 Oak Street
Faulkton, SD 57438-0100
Medicare Provider Number
431301
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
VILAS
Pharmacy Address
DAKOTA PHARMS, LLC
103 E COMMERCIAL AVE
GETTYSBURG, SD 57442
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Susan Miller, CFO
(605) 598-6262 Ext: 1140
Contract Pharmacy Representative
Custer Community Pharmacy
Dillon Kjerstad, Co-owner
(605) 859-2833
Signed By Date
4/8/2020
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