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THRIFTY WHITE DRUG #750
CAH241320-00 RiverView Healthcare Association
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Covered Entity Details
Entity Name
RiverView Healthcare Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241320-00
Entity Address
323 S. Minnesota Street
Crookston, MN 56716
Medicare Provider Number
241320
Participating Start Date
1/1/2014
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE DRUG #750
Pharmacy Address
203 MILL STREET N
P.O. BOX 337
FERTILE, MN 56540
Pharmacy Comments
Contract Details
Approval Date
4/15/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Betty Arvidson, CFO
(218) 281-9756
Contract Pharmacy Representative
THRIFTY WHITE
Alicia Hager, Pharmacy Operations Specialist
(763) 463-4482
Signed By Date
4/15/2014
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