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WHITE DRUG #52
CAH161300-00 BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER
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Covered Entity Details
Entity Name
BAUM HARMON MERCY HOSPITAL DBA MERCYONE PRIMGHAR MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH161300-00
Entity Address
255 NORTH WELCH AVENUE
PRIMGHAR, IA 51245
Medicare Provider Number
161300
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
WHITE DRUG #52
Pharmacy Address
706 38TH ST N STE B
FARGO, ND 58102-2953
Pharmacy Comments
Contract Details
Approval Date
7/7/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SUE E MCCAULEY, CAH FINANCE MANAGER-BHMH OMH
(712) 957-2300 Ext: 2303
Contract Pharmacy Representative
Thrifty White
Timothy Weippert, EVP of Pharmacy
(763) 513-4365
Signed By Date
7/7/2017
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