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SEIP DRUG
CAH241373-00 PERHAM HOSPITAL DISTRICT DBA PERHAM HEALTH
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Covered Entity Details
Entity Name
PERHAM HOSPITAL DISTRICT DBA PERHAM HEALTH
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241373-00
Entity Address
1000 Coney Street West
PERHAM, MN 56573
Medicare Provider Number
241373
Participating Start Date
1/1/2011
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
SEIP DRUG
Pharmacy Address
97 MILLER ST
P.O. BOX 98
NEW YORK MILLS, MN 56567
Pharmacy Comments
Contract Details
Approval Date
11/15/2011
Contract Begin Date
11/15/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHARLES A. HOFIUS, CEO
(218) 347-1301
Contract Pharmacy Representative
Seip Drug
Nate Seip, CEO
(218) 385-3360
Signed By Date
11/7/2011
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