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BOTTINEAU CLINIC PHARMACY INC
CAH351307-00 SMP HEALTH ST ANDREWS
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Covered Entity Details
Entity Name
SMP HEALTH ST ANDREWS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351307-00
Entity Address
316 OHMER ST
BOTTINEAU, ND 58318
Medicare Provider Number
351307
Participating Start Date
10/1/2021
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
BOTTINEAU CLINIC PHARMACY INC
Pharmacy Address
314 OHMER STREET
BOTTINEAU, ND 58318
Pharmacy Comments
Contract Details
Approval Date
1/13/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Courtney Vandal, CFO
(701) 228-9353
Contract Pharmacy Representative
Pharmacists Associates LLC
Shane Wendel, Pharmacist
(701) 652-5810
Signed By Date
1/13/2022
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