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ST JOSEPH'S MCAULEY PHARMACY
CAH241377-00 ST. FRANCIS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. FRANCIS MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241377-00
Entity Address
2400 ST. FRANCIS DR
BRECKENRIDGE, MN 56520
Medicare Provider Number
241377
Participating Start Date
1/1/2011
Last Recertification Date
8/23/2024
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
7/15/2020
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
DAVID NELSON, CEO
(218) 643-0400
Contract Pharmacy Representative
St. Joseph's Hospital and Medical Center
Greg Blank, Director of Pharmacy
(602) 406-4744
Signed By Date
7/15/2020
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