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WALL'S MEDICINE CENTER INC
CH0811510 SPECTRA HEALTH
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Covered Entity Details
Entity Name
SPECTRA HEALTH
Subdivision Name
Spectra Health Admin Office
Type
HRSA-Funded Health Center
340B ID
CH0811510
Entity Address
212 South 4th Street, Suite 200
Grand Forks, ND 58201-0160
Grant Number
H80CS01808
Participating Start Date
7/1/2007
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WALL'S MEDICINE CENTER INC
Pharmacy Address
708 S WASHINGTON ST
GRAND FORKS, ND 58201-4328
Pharmacy Comments
Contract Details
Approval Date
7/16/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Douglas Jaeger, CEO
(701) 587-8000
Contract Pharmacy Representative
Prairie Pharmacy FA1
Dennis Johnson, Owner
(701) 314-0056
Signed By Date
7/16/2014
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