340B Drug Pricing Program Database

Pharmacy Name

COBORN'S PHARMACY #16

Pharmacy Address

645 LAKE ST. S.
LONG PRAIRIE, MN 56347

Pharmacy Comments

Approval Date

9/12/2012

Contract Begin Date

9/12/2012

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

DANIEL SWENSON, ADMINSTRATOR/CEO
(320) 732-7210

Contract Pharmacy Representative

Coborn's
Jim Cox, 340B Program Director
(320) 257-5505

Signed By Date

8/31/2012