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THRIFTY WHITE PHARMACY #065
CAH351326-00 First Care Health Center
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Covered Entity Details
Entity Name
First Care Health Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351326-00
Entity Address
115 Vivian Street
Park River, ND 58270
Medicare Provider Number
351326
Participating Start Date
1/1/2014
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #065
Pharmacy Address
737 W 12TH ST
GRAFTON, ND 58237-2117
Pharmacy Comments
Contract Details
Approval Date
1/19/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louise Dryburgh, CEO
(701) 284-7500 Ext: 538
Contract Pharmacy Representative
Thrifty White
Timothy Weippert, EVP of Pharmacy
(763) 513-4365
Signed By Date
1/19/2017
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