Contract Pharmacy Details

THRIFTY WHITE PHARMACY #022
SCH240088-00 Rice Memorial Hospital

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

THRIFTY WHITE PHARMACY #022

Pharmacy Address

2300 1ST ST S
WILLMAR, MN 56201

Pharmacy Comments

Contract Details

Approval Date

4/15/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/11/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

William Fenske, Chief Financial Officer
(320) 231-4009

Contract Pharmacy Representative

Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554

Signed By Date

4/15/2016

340B Drug Pricing Program Database