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WEBER & JUDD - SOUTH BROADWAY
DSH240006 OLMSTED MEDICAL CENTER
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Covered Entity Details
Entity Name
OLMSTED MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240006
Entity Address
1650 4TH STREET SE
ROCHESTER, MN 55904
Medicare Provider Number
240006
Participating Start Date
7/1/2010
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
WEBER & JUDD - SOUTH BROADWAY
Pharmacy Address
18 9TH ST SE
ROCHESTER, MN 55904
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2019
Ownership change
Contacts
Covered Entity Signing Official
Kevin Higgins, Chief Financial Officer
(507) 529-6619
Contract Pharmacy Representative
Wade Hanson, Owner
(507) 536-4410
Signed By Date
7/11/2014
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