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NUCARA PHARMACY #34
CAH351311-00 LISBON AREA HEALTH SERVICES
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Covered Entity Details
Entity Name
LISBON AREA HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351311-00
Entity Address
905 MAIN ST
LISBON, ND 58054
Medicare Provider Number
351311
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
NUCARA PHARMACY #34
Pharmacy Address
NUDAK VENTURES NORTH DAKOTA LLC
407 MAIN ST
PO BOX 601
LISBON, ND 58054-4143
Pharmacy Comments
Contract Details
Approval Date
7/16/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith Heuser, President
(701) 845-6400
Contract Pharmacy Representative
Nudak Ventures LLC
Lori Willis, Acquisitions Manager
(641) 366-3440 Ext: 127
Signed By Date
7/16/2021
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