Contract Pharmacy Details

HOFFMAN DRUG
CAH431306-02 Platte Community Memorial Hospital, Inc.

Covered Entity Details

Entity Name

Platte Community Memorial Hospital, Inc.

Subdivision Name

Geddes Medical Clinic

Type

Critical Access Hospital

340B ID

CAH431306-02

Entity Address

322 Main Street
Geddes, SD 57342

Medicare Provider Number

431306

Outpatient Facility Provider Number

433414

Participating Start Date

4/1/2013

Last Recertification Date

8/19/2024

Pharmacy Details

Pharmacy Name

HOFFMAN DRUG

Pharmacy Address

408 MAIN
PO BOX 110
PLATTE, SD 57369-0110

Pharmacy Comments

Contract Details

Approval Date

4/10/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Mark Burket, CEO
(605) 337-3364

Contract Pharmacy Representative

Lois Hoffman, Owner
(605) 337-3662

Signed By Date

4/10/2013

340B Drug Pricing Program Database