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THRIFTY WHITE PARTNERS IN CARE
CAH241336-00 KITTSON MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KITTSON MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241336-00
Entity Address
1010 S BIRCH AVE
HALLOCK, MN 56728
Medicare Provider Number
241336
Participating Start Date
4/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PARTNERS IN CARE
Pharmacy Address
706 38TH ST NW UNIT B
FARGO, ND 58102
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/26/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brenda Parnell, CFO
(907) 229-3546
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
10/14/2022
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