Contract Pharmacy Details

LEWIS FAMILY DRUG #66
CAH431333-00 SANFORD CANTON-INWOOD MEDICAL CENTER

Covered Entity Details

Entity Name

SANFORD CANTON-INWOOD MEDICAL CENTER

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH431333-00

Entity Address

440 NORTH HIAWATHA DRIVE
CANTON, SD 57013

Medicare Provider Number

431333

Participating Start Date

4/1/2011

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

LEWIS FAMILY DRUG #66

Pharmacy Address

911 W CEDAR ST STE 1
BERESFORD, SD 57004-1608

Pharmacy Comments

Contract Details

Approval Date

4/15/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stan Knobloch, Director of Finance
(712) 472-6143

Contract Pharmacy Representative

Lewis Drug
Scott Cross, EVP
(605) 367-2800

Signed By Date

4/15/2021

340B Drug Pricing Program Database