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FAIRVIEW SPECIALTY SERVICES PHARMACY
CAH241313-00 BRIDGES MEDICAL CENTER
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Covered Entity Details
Entity Name
BRIDGES MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241313-00
Entity Address
201 9TH ST W
ADA, MN 56510
Medicare Provider Number
241313
Participating Start Date
9/28/2010
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW SPECIALTY SERVICES PHARMACY
Pharmacy Address
711 KASOTA AVENUE SE, SUITE A
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/15/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ryan Hill, Administrator
(218) 784-5201
Contract Pharmacy Representative
University of Minnesota Medical Center
Jesse Peterson, 340B Program Director
(612) 672-5179
Signed By Date
4/13/2018
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