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CHI HEALTH SPECIALTY PHARMACY
CAH351334-00 MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH351334-00
Entity Address
1301 15TH AVE. WEST
WILLISTON, ND 58801
Medicare Provider Number
351334
Participating Start Date
9/13/2010
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
CHI HEALTH SPECIALTY PHARMACY
Pharmacy Address
7710 MERCY RD STE 102
OMAHA, NE 68124-2339
Pharmacy Comments
Contract Details
Approval Date
4/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/22/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Joseph Lawrence Ruark, VP, Operational Finance
(701) 774-7408
Contract Pharmacy Representative
Alegent Creighton Health
Michael Tiesi, Regional Senior Director of Pharmacy Services
(402) 717-2614
Signed By Date
4/3/2018
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