Contract Pharmacy Details

HAZEN DRUG
CAH351310-00 SAKAKAWEA MEDICAL CENTER

Covered Entity Details

Entity Name

SAKAKAWEA MEDICAL CENTER

Subdivision Name

DBA SAKAKAWEA MEDICAL CENTER

Type

Critical Access Hospital

340B ID

CAH351310-00

Entity Address

510 8TH AVE NE
HAZEN, ND 58545

Medicare Provider Number

351310

Participating Start Date

7/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

HAZEN DRUG

Pharmacy Address

30 MAIN ST
HAZEN, ND 58545-4205

Pharmacy Comments

Contract Details

Approval Date

4/8/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Darrold Bertsch, CEO
(701) 748-2225 Ext: 240

Contract Pharmacy Representative

Mike Chase, RPh
(701) 748-2312

Signed By Date

4/8/2013