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FAMILY PHARMACY OF MOBRIDGE
CHC00349-02 PRAIRIE COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
PRAIRIE COMMUNITY HEALTH INC
Subdivision Name
Isabel Community Clinic
Type
HRSA-Funded Health Center
340B ID
CHC00349-02
Entity Address
118 NORTH MAIN
ISABEL, SD 57633-0097
Grant Number
H80CS00349
Participating Start Date
10/1/2009
Last Recertification Date
3/3/2016
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY OF MOBRIDGE
Pharmacy Address
FAMILY PHARMACY OF MOBRIDGE, INC
323 N MAIN ST
MOBRIDGE, SD 57601
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/25/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
PAM LOCKEN, CEO
(605) 466-2120
Contract Pharmacy Representative
Russell Hatch, Owner - Pharmacist
(605) 845-3345
Signed By Date
1/15/2015
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