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WHITE DRUG #52
CAH241306-00 HealthPartners RC dba Olivia Hospital & Clinic
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Covered Entity Details
Entity Name
HealthPartners RC dba Olivia Hospital & Clinic
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241306-00
Entity Address
100 Healthy Way
Olivia, MN 56277-1117
Medicare Provider Number
241306
Participating Start Date
10/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WHITE DRUG #52
Pharmacy Address
706 38TH ST N STE B
FARGO, ND 58102-2953
Pharmacy Comments
Contract Details
Approval Date
10/3/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/27/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Nathan Blad, President
(320) 523-3575
Contract Pharmacy Representative
Thrifty White
Timothy Weippert, EVP of Pharmacy
(763) 513-4365
Signed By Date
10/3/2016
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