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FAIRVIEW SPECIALTY SERVICES PHARMACY
CAH241329-00 LAKEWOOD HEALTH SYSTEM
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Covered Entity Details
Entity Name
LAKEWOOD HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241329-00
Entity Address
49725 COUNTY 83
STAPLES, MN 56479
Medicare Provider Number
241329
Participating Start Date
9/24/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW SPECIALTY SERVICES PHARMACY
Pharmacy Address
711 KASOTA AVENUE SE, SUITE A
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joseph Thomas Reycraft, CFO
(218) 894-8194
Contract Pharmacy Representative
Fairview
Tim Affeldt, VP of Operations
(612) 672-5127
Signed By Date
7/17/2023
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