Contract Pharmacy Details

SHOPKO PHARMACY #2023
SCH240187-04 HUTCHINSON HEALTH CARE

Covered Entity Details

Entity Name

HUTCHINSON HEALTH CARE

Subdivision Name

Hutchinson Health Mental Health Clinic

Type

Sole Community Hospital

340B ID

SCH240187-04

Entity Address

1071 Highway 15 South
Hutchinson, MN 55350

Medicare Provider Number

240187

Outpatient Facility Provider Number

Participating Start Date

1/1/2015

Last Recertification Date

9/1/2015

Entity Termination Date

7/1/2016

Pharmacy Details

Pharmacy Name

SHOPKO PHARMACY #2023

Pharmacy Address

125 MAIN STREET NORTH
HUTCHINSON, MN 55350-1807

Pharmacy Comments

Contract Details

Approval Date

1/15/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/27/2016
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Pamela J. Larson, CFO
(320) 484-4472

Contract Pharmacy Representative

Matt Alvey, Pharmacy Manager
(320) 587-4941

Signed By Date

1/15/2015