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CROSSLAKE DRUG
SCH240075-00 ST JOSEPHS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPHS MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240075-00
Entity Address
523 N 3RD ST
BRAINERD, MN 56401
Medicare Provider Number
240075
Participating Start Date
4/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CROSSLAKE DRUG
Pharmacy Address
14311 GOULD ST
PO BOX 578
CROSSLAKE, MN 56442-5501
Pharmacy Comments
Contract Details
Approval Date
7/4/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bradley Beard, Chief Operating Officer
(218) 786-2652
Contract Pharmacy Representative
Crosslake Drug
Steve Kappes, Owner
(218) 692-2502
Signed By Date
7/4/2023
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