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CASH WISE PHARMACY
SCH240088-00 Rice Memorial Hospital
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Covered Entity Details
Entity Name
Rice Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240088-00
Entity Address
301 Becker Ave. SW
Willmar, MN 56201
Medicare Provider Number
240088
Participating Start Date
10/1/2011
Last Recertification Date
11/16/2017
Entity Termination Date
6/25/2018
Pharmacy Details
Pharmacy Name
CASH WISE PHARMACY
Pharmacy Address
CASH WISE PHARMACY #3004
1300 5TH ST SE
WILLMAR, MN 56201-5321
Pharmacy Comments
Contract Details
Approval Date
1/2/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/28/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
William Fenske, Chief Financial Officer
(320) 231-4009
Contract Pharmacy Representative
Jim Cox, Director of Pharmacy
(320) 251-5505
Signed By Date
1/2/2015
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