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MELROSE PHARMACY INC
CAH241330-00 CENTRACARE HEALTH SYSTEM - MELROSE
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Covered Entity Details
Entity Name
CENTRACARE HEALTH SYSTEM - MELROSE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241330-00
Entity Address
525 MAIN ST WEST
MELROSE, MN 56352
Medicare Provider Number
241330
Participating Start Date
4/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MELROSE PHARMACY INC
Pharmacy Address
611 WEST MAIN STREET
MELROSE, MN 56352
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GERRY Gordon GILBERTSON, HOSPITAL ADMINISTRATOR
(320) 256-4231 Ext: 24205
Contract Pharmacy Representative
Prairie Pharmacy
Jeff Sawyer, Pharmacist
(320) 256-7292
Signed By Date
7/15/2013
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