Contract Pharmacy Details

KEYCARE PHARMACY
SCH350006-00 TRINITY HOSPITALS

Covered Entity Details

Entity Name

TRINITY HOSPITALS

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH350006-00

Entity Address

2305 37th Ave SW
MINOT, ND 58701

Medicare Provider Number

350006

Participating Start Date

7/1/2016

Last Recertification Date

9/5/2024

Pharmacy Details

Pharmacy Name

KEYCARE PHARMACY

Pharmacy Address

400 BURDICK EXPRESSWAY EAST
MINOT, ND 58701

Pharmacy Comments

Contract Details

Approval Date

7/4/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/15/2023
Agreement registered in error

Contacts

Covered Entity Signing Official

Dennis Empey, VP/CFO
(701) 857-5160

Contract Pharmacy Representative

Lance Mohl, Director
(701) 838-2213

Signed By Date

7/4/2016