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PARK NICOLLET PHARMACY #87017
CAH241306-00 HealthPartners RC dba Olivia Hospital & Clinic
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Covered Entity Details
Entity Name
HealthPartners RC dba Olivia Hospital & Clinic
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241306-00
Entity Address
100 Healthy Way
Olivia, MN 56277-1117
Medicare Provider Number
241306
Participating Start Date
10/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
PARK NICOLLET PHARMACY #87017
Pharmacy Address
3800 PARK NICOLLET BLVD STE 1170
ST LOUIS PARK, MN 55416-2527
Pharmacy Comments
Contract Details
Approval Date
7/8/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nancy Ann Anderson, Chief Financial Officer
(320) 523-3477
Contract Pharmacy Representative
HealthPartners
David L. Busch, VP of Pharmacy Operations
(952) 967-5049
Signed By Date
7/8/2022
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