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GRAND MARAIS PHARMACY
CH052700 SAWTOOTH MOUNTAIN CLINIC INC
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Covered Entity Details
Entity Name
SAWTOOTH MOUNTAIN CLINIC INC
Subdivision Name
SAWTOOTH MOUNTAIN CLINIC
Type
HRSA-Funded Health Center
340B ID
CH052700
Entity Address
513 5th Ave W
Grand Marais, MN 55604-3017
Grant Number
H80CS00496
Participating Start Date
1/1/2004
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
GRAND MARAIS PHARMACY
Pharmacy Address
425 W HIGHWAY 61
PO BOX 365
GRAND MARAIS, MN 55604-0365
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
RITA M. PLOURDE, CEO
(218) 387-2330
Contract Pharmacy Representative
Robert S. Sample, Owner
(218) 370-8273
Signed By Date
10/14/2014
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