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B & B NORTHWEST PHARMACY
SCH350006-00 TRINITY HOSPITALS
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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
B & B NORTHWEST PHARMACY
Pharmacy Address
20 BURDICK EXPWY WEST
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
4/28/2023
Pharmacy closed
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
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