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THRIFTY WHITE PHARMACY #047
CAH351308-00 NELSON COUNTY HEALTH SYSTEM-HOSPITAL
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Covered Entity Details
Entity Name
NELSON COUNTY HEALTH SYSTEM-HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351308-00
Entity Address
200 NORTH MAIN STREET
MCVILLE, ND 58254
Medicare Provider Number
351308
Participating Start Date
7/1/2017
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #047
Pharmacy Address
323 5TH ST NE STE 2
P.O. BOX 772
DEVILS LAKE, ND 58301
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
Samantha Harding Harding, CEO
(701) 322-4314
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
10/17/2022
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