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MAYO CLINIC PHARMACY
CAH241338-00 MAYO CLNIC HEALTH SYSTEM - LAKE CITY
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Covered Entity Details
Entity Name
MAYO CLNIC HEALTH SYSTEM - LAKE CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241338-00
Entity Address
500 WEST GRANT ST
LAKE CITY, MN 55041
Medicare Provider Number
241338
Participating Start Date
10/1/2023
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
7/16/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eric Douglas Crockett, Regional Chair-Administration
(507) 422-5678 Ext: 5079909402
Contract Pharmacy Representative
Mayo Clinic
Jordan Daniel Haag, Associate Chief Pharmacy Officer
(507) 284-5722
Signed By Date
7/16/2024
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