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Care 4US Pharmacy
FQHC638537A Prairie Island Indian Community
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Covered Entity Details
Entity Name
Prairie Island Indian Community
Subdivision Name
Prairie Island Health Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638537A
Entity Address
5636 Sturgeon Lake Rd
Welch, MN 55089
Grant Number
Participating Start Date
7/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
Care 4US Pharmacy
Pharmacy Address
1665 US HIghway 70
Suite 102
Bartlett TN, TN 38133
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Gnotke, Finance Director
(651) 385-4111
Contract Pharmacy Representative
A-S Medication Solutions LLC
Matthew J Hoff, EVP
(678) 488-7524
Signed By Date
10/17/2022
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