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DAKOTA CLINIC PHARMACY
RRC350070-00 INNOVIS HEALTH
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Covered Entity Details
Entity Name
INNOVIS HEALTH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC350070-00
Entity Address
3000 32ND AVENUE S
FARGO, ND 58103
Medicare Provider Number
350070
Participating Start Date
4/1/2022
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
DAKOTA CLINIC PHARMACY
Pharmacy Address
ON SU DRIVE
1702 UNIVERSITY DR S
FARGO, ND 58103-4940
Pharmacy Comments
Contract Details
Approval Date
1/26/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Al Hurley, COO
(701) 364-7667
Contract Pharmacy Representative
Dakota Clinic Pharmacy
Laura Morris, Owner
(701) 364-3450
Signed By Date
1/26/2023
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