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THRIFTY WHITE PHARMACY #746
CAH241328-00 Sanford Bagley Medical Center
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Covered Entity Details
Entity Name
Sanford Bagley Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241328-00
Entity Address
203 4TH ST. NW
BAGLEY, MN 56621
Medicare Provider Number
241328
Participating Start Date
1/1/2011
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #746
Pharmacy Address
31 MAIN AVE N
PO BOX F
BAGLEY, MN 56621
Pharmacy Comments
Contract Details
Approval Date
1/26/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CRAIG O. BOYER, Vice President of Finance
(218) 333-5508
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
1/26/2016
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