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THRIFTY WHITE PHARMACY #782
CAH241367-00 Welia Health
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Covered Entity Details
Entity Name
Welia Health
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241367-00
Entity Address
301 Hwy 65 S
Mora, MN 55051
Medicare Provider Number
241367
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #782
Pharmacy Address
45 LADY LUCK DRIVE
P.O. BOX 306
HINCKLEY, MN 55037
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/3/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Randy Ulseth, CEO
(320) 225-3315
Contract Pharmacy Representative
Thrifty White
Timothy Weippert, EVP of Pharmacy
(763) 513-4365
Signed By Date
4/15/2014
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