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GERMAN DOBSON CVS, L.L.C.
CAH241376-00 GLACIAL RIDGE HEALTH SYSTEM
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Covered Entity Details
Entity Name
GLACIAL RIDGE HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241376-00
Entity Address
10 FOURTH AVE SE
GLENWOOD, MN 56334
Medicare Provider Number
241376
Participating Start Date
10/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
GERMAN DOBSON CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01743
13870 W. GREENWAY RD.
SURPRISE, AZ 85374
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KYLE CHASE, CFO
(320) 634-2206
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2021
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