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LEWIS FAMILY DRUG #58
CAH431328-00 Pioneer Memorial Hospital & Health Services
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Covered Entity Details
Entity Name
Pioneer Memorial Hospital & Health Services
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431328-00
Entity Address
315 N Washington St
Viborg, SD 57070-0368
Medicare Provider Number
431328
Participating Start Date
4/1/2013
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
LEWIS FAMILY DRUG #58
Pharmacy Address
LEWIS FAMILY DRUG, LLC
104 W PARK AVE
LEWIS FAMILY DRUG LLC
VIBORG, SD 57070-2048
Pharmacy Comments
Contract Details
Approval Date
7/13/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Anne Christiansen, CFO
(605) 326-5161 Ext: 3004
Contract Pharmacy Representative
Lewis Drug
Scott Cross, EVP
(605) 367-2800
Signed By Date
7/13/2015
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