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SANFORD PHARMACY THIEF RIVER FALLS
CAH241381-00 SANFORD THIEF RIVER FALLS
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Covered Entity Details
Entity Name
SANFORD THIEF RIVER FALLS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241381-00
Entity Address
3001 SANFORD PARKWAY
THIEF RIVER FALLS, MN 56701-2819
Medicare Provider Number
241381
Participating Start Date
4/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
SANFORD PHARMACY THIEF RIVER FALLS
Pharmacy Address
RETAIL PHARMACY
3001 SANFORD PKWY
THIEF RIVER FALLS, MN 56701
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/4/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Casey Johnson, CFO
(218) 683-4636
Contract Pharmacy Representative
Sanford Health
Jesse Breidenbach, Vice President, Pharmacy
(701) 234-6887
Signed By Date
10/14/2013
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