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LARIMORE DRUG AND GIFT INC
CAH351312-00 NORTHWOOD DEACONESS HEALTH CENTER
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Covered Entity Details
Entity Name
NORTHWOOD DEACONESS HEALTH CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351312-00
Entity Address
4 N PARK STREET
NORTHWOOD, ND 58267
Medicare Provider Number
351312
Participating Start Date
4/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
LARIMORE DRUG AND GIFT INC
Pharmacy Address
203 TOWNER AVENUE
BOX 438
LARIMORE, ND 58251
Pharmacy Comments
Contract Details
Approval Date
3/19/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/1/2020
Ownership change
Contacts
Covered Entity Signing Official
Pete Antonson, CFO
(701) 587-6459
Contract Pharmacy Representative
Dorothy Farrell, Pharmacist
(701) 343-2461
Signed By Date
3/19/2015
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