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THRIFTY WHITE DRUG #722
CAH241359-00 AVERA MARSHALL
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Covered Entity Details
Entity Name
AVERA MARSHALL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241359-00
Entity Address
300 S BRUCE STREET
MARSHALL, MN 56258-1934
Medicare Provider Number
241359
Participating Start Date
9/28/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE DRUG #722
Pharmacy Address
321 W MAIN ST
MARSHALL, MN 56258
Pharmacy Comments
Contract Details
Approval Date
1/18/2012
Contract Begin Date
1/18/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/19/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
SHARON WILLIAMS, VP OF FINANCE AND IT
(507) 537-9150
Contract Pharmacy Representative
Thrifty White
Timothy Weippert, EVP of Pharmacy
(763) 513-4365
Signed By Date
12/14/2011
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