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DENALI PHARMACY
DSH020012 FAIRBANKS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
FAIRBANKS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH020012
Entity Address
1650 COWLES STREET
FAIRBANKS, AK 99701-5998
Medicare Provider Number
020012
Participating Start Date
9/9/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
DENALI PHARMACY
Pharmacy Address
1650 COWLES ST
FAIRBANKS, AK 99701
Pharmacy Comments
Contract Details
Approval Date
1/13/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim Lynch, CFO
(907) 458-5300
Contract Pharmacy Representative
Denali Pharmacy
Karen Miller, Director
(907) 458-5257
Signed By Date
1/13/2017
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