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FAMILY PHARMACY OF MOBRIDGE
CAH431325-00 Mobridge Regional Hospital
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Covered Entity Details
Entity Name
Mobridge Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH431325-00
Entity Address
1401 10th Avenue West
Mobridge, SD 57601
Medicare Provider Number
431325
Participating Start Date
10/1/2013
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
FAMILY PHARMACY OF MOBRIDGE
Pharmacy Address
FAMILY PHARMACY OF MOBRIDGE, INC
323 N MAIN ST
MOBRIDGE, SD 57601
Pharmacy Comments
Contract Details
Approval Date
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angelia K. Svihovec, CEO
(605) 845-8105
Contract Pharmacy Representative
Russell Hatch, Owner - Pharmacist
(605) 845-3345
Signed By Date
4/14/2014
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