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THRIFTY WHITE PHARMACY #780
SCH350019-00 ALTRU HOSPITAL
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Covered Entity Details
Entity Name
ALTRU HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH350019-00
Entity Address
1200 SOUTH COLUMBIA ROAD
GRAND FORKS, ND 58201
Medicare Provider Number
350019
Participating Start Date
8/5/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
THRIFTY WHITE PHARMACY #780
Pharmacy Address
310 LAKE STREET
P.O. BOX 450
WARROAD, MN 56763
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DWIGHT William THOMPSON, CFO
(701) 780-5211
Contract Pharmacy Representative
Thrifty White
Zach Winter, Corporate Manager
(763) 248-7554
Signed By Date
4/12/2018
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