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DBA NUCARA PHARMACY #23
CAH241349-00 CENTRACARE HEALTH - PAYNESVILLE
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Covered Entity Details
Entity Name
CENTRACARE HEALTH - PAYNESVILLE
Subdivision Name
CENTRACARE HEALTH - PAYNESVILLE HOSPITAL
Type
Critical Access Hospital
340B ID
CAH241349-00
Entity Address
200 FIRST ST W
PAYNESVILLE, MN 56362
Medicare Provider Number
241349
Participating Start Date
4/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
DBA NUCARA PHARMACY #23
Pharmacy Address
NUDAK VENTURES LLC
216 WASHBURNE AVE.
PAYNESVILLE, MN 56362-1641
Pharmacy Comments
Contract Details
Approval Date
4/23/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis Miley, Administrator
(320) 243-3767 Ext: 42101
Contract Pharmacy Representative
Brian Wegmann, CEO
(641) 366-3440
Signed By Date
4/23/2014
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