Contract Pharmacy Details

TIOGA DRUG
CAH351300-00 Tioga Medical Center

Covered Entity Details

Entity Name

Tioga Medical Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH351300-00

Entity Address

810 N Welo St
Tioga, ND 58852-0159

Medicare Provider Number

351300

Participating Start Date

1/1/2014

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

TIOGA DRUG

Pharmacy Address

PO BOX 639
106 N. MAIN ST
TIOGA, ND 58852

Pharmacy Comments

Contract Details

Approval Date

1/13/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ryan Mickelsen, Pres/CEO
(701) 664-3308 Ext: 102

Contract Pharmacy Representative

Tim Joyce, Pharmacist / Owner
(701) 664-2463

Signed By Date

1/13/2014