340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WAL-MART PHARMACY 10-1858
CAH241343-00 AVERA GRANITE FALLS
Print
Covered Entity Details
Entity Name
AVERA GRANITE FALLS
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241343-00
Entity Address
345 10TH AVE
GRANITE FALLS, MN 56241
Medicare Provider Number
241343
Participating Start Date
9/29/2010
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1858
Pharmacy Address
3001 EAST HWY 7, STE 100
MONTEVIDEO, MN 56265
Pharmacy Comments
Contract Details
Approval Date
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Kooiman, ADMINISTRATOR/CEO
(320) 564-6201
Contract Pharmacy Representative
Granite Falls Health
Janel Sue Torgerson, Pharmacy Manager
(320) 564-3111 Ext: 6219
Signed By Date
10/11/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session