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MS4 PLLC
CAH241365-00 CENTRACARE HEALTH - BENSON, LLC
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Covered Entity Details
Entity Name
CENTRACARE HEALTH - BENSON, LLC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241365-00
Entity Address
1815 Wisconsin Avenue
Benson, MN 56215
Medicare Provider Number
241365
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MS4 PLLC
Pharmacy Address
DBA THE MEDICINE SHOPPE
503 14TH ST S
BENSON, MN 56215
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dan Enderson, CFO
(320) 843-4232
Contract Pharmacy Representative
Medicine Shoppe Benson
Kyle Hilleran, Owner
(320) 808-6157
Signed By Date
10/10/2022
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