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ALTRU CLINIC PHARMACY - FAMILY MED CTR I
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
ALTRU CLINIC PHARMACY - FAMILY MED CTR I
Pharmacy Address
1380 S COLUMBIA RD
GRAND FORKS, ND 58201-4059
Pharmacy Comments
Contract Details
Approval Date
9/26/2012
Contract Begin Date
9/26/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dwight Thompson, CFO
(701) 780-5211
Contract Pharmacy Representative
Scott Hulst, Secretary Treasurer
(701) 795-2020
Signed By Date
9/21/2012
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