Contract Pharmacy Details

SHOPKO PHARMACY #2036
DSH240006 OLMSTED MEDICAL CENTER

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

SHOPKO PHARMACY #2036

Pharmacy Address

3708 HIGHWAY 63 NORTH
ROCHESTER, MN 55906-3927

Pharmacy Comments

Contract Details

Approval Date

10/10/2014

Contract Begin Date

1/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Kevin Higgins, Chief Financial Officer
(507) 529-6619

Contract Pharmacy Representative

ShopKo
Lorie Neumann, Contracting & Compliance
(920) 429-4726

Signed By Date

10/10/2014

340B Drug Pricing Program Database