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PRAIRIE PHARMACY FA1
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
PRAIRIE PHARMACY FA1
Pharmacy Address
NORTH PRAIRIE PHARMACIES LLC
4731 13TH AVE S
FARGO, ND 58103
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tiffany Schmidt, CFO
(701) 757-2100 Ext: 2002
Contract Pharmacy Representative
Prairie Pharmacy FA1
Dennis Johnson, Owner
(701) 314-0056
Signed By Date
4/11/2025
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