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ST JOSEPH'S MCAULEY PHARMACY
CAH351333-00 Mercy Hospital of Devils Lake d/ba/ CHI St. Alexius Health Devils Lake Hospital
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Covered Entity Details
Entity Name
Mercy Hospital of Devils Lake d/ba/ CHI St. Alexius Health Devils Lake Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351333-00
Entity Address
1031 7th St NE
Devils Lake, ND 58301-2798
Medicare Provider Number
351333
Participating Start Date
9/29/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ST JOSEPH'S MCAULEY PHARMACY
Pharmacy Address
DIGNITY HEALTH
500 W THOMAS RD, STE 190
PHOENIX, AZ 85013-4237
Pharmacy Comments
Contract Details
Approval Date
7/6/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/30/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Andrew Joseph Lankowicz, President
(701) 662-9710
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
7/6/2020
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