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PHARMACISTS ASSOCIATES LLC
CAH351306-00 COOPERSTOWN MEDICAL CENTER dba Dakota Regional Medical Center
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Covered Entity Details
Entity Name
COOPERSTOWN MEDICAL CENTER dba Dakota Regional Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351306-00
Entity Address
107 12th St. S
COOPERSTOWN, ND 58425-7101
Medicare Provider Number
351306
Participating Start Date
1/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PHARMACISTS ASSOCIATES LLC
Pharmacy Address
DBA LAKOTA DRUG
117 MAIN ST N
LAKOTA, ND 58344
Pharmacy Comments
Contract Details
Approval Date
2/19/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole L. Lindsey, CEO
(701) 786-1703
Contract Pharmacy Representative
Lakota Drug & Gift
Shane Wendel, Owner
(701) 247-2781
Signed By Date
2/19/2025
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