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AASEN DRUG INC
CAH351309-00 SANFORD MEDICAL CENTER MAYVILLE
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Covered Entity Details
Entity Name
SANFORD MEDICAL CENTER MAYVILLE
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351309-00
Entity Address
42 6TH AVENUE SE
MAYVILLE, ND 58257
Medicare Provider Number
351309
Participating Start Date
10/1/2011
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
AASEN DRUG INC
Pharmacy Address
15 MAIN ST E
MAYVILLE, ND 58257-1435
Pharmacy Comments
Contract Details
Approval Date
4/20/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROGER BAIER, CEO
(701) 788-4433
Contract Pharmacy Representative
Aasen Drug
Marcus Aasen, President
(701) 788-2552
Signed By Date
4/20/2015
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