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WALLS ALTRU PHARM INC D/B/A WALLS HEALTH
SCH350019-00 ALTRU HOSPITAL
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Covered Entity Details
Entity Name
ALTRU HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH350019-00
Entity Address
1200 SOUTH COLUMBIA ROAD
GRAND FORKS, ND 58201
Medicare Provider Number
350019
Participating Start Date
8/5/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
WALLS ALTRU PHARM INC D/B/A WALLS HEALTH
Pharmacy Address
4440 S WASHINGTON ST STE 101-D
GRAND FORKS, ND 58201-7245
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/26/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/19/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Dwight Thompson, CFO
(701) 780-5211
Contract Pharmacy Representative
Prairie Pharmacy FA1
Dennis Johnson, Owner
(701) 314-0056
Signed By Date
9/21/2012
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