CLIA lab
CLIA 24D2189091: Mountain Lake Pharmacy LLC
Mountain Lake, MN. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 24D2189091 belongs to Mountain Lake Pharmacy LLC in Mountain Lake, MN.
Certificate of Waiver, effective July 27, 2026, expires July 26, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- July 27, 2026
- Certificate expiration
- July 26, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- July 27, 2020
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 24D2189091
- Lab name
- Mountain Lake Pharmacy LLC
- Additional name
- DBA Peterson Drug An
- Address
- 1007 3rd Avenue, Mountain Lake, MN 56159
- Phone
- (507) 427-2707
- Fax
- (507) 427-2328
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Mountain Lake, MN
- Good Samaritan VillageCertificate of Waiver, Skilled nursing or nursing facility24D0664275
- Sanford Health - Mountain Lake ClinicCertificate of Waiver, Rural health clinic24D0405271
- Sanford Laboratories - Mountain LakeCertificate of Accreditation, Independent24D1061124
- The Lodge of Mountain LakeCertificate of Waiver, Assisted living facility24D1016198
Related
Questions
What is the CLIA number for Mountain Lake Pharmacy LLC in Mountain Lake?
24D2189091, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Mountain Lake Pharmacy LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 24D2189091 expire?
The CMS file lists July 26, 2028 as the certificate expiration date; the certificate took effect July 27, 2026.