Covered Entity Details

RRC240047-17 ST. LUKES HOSPITAL OF DULUTH (Terminated) - information as of 5/30/2025 8:11:35 PM

Main Details

Name

ST. LUKES HOSPITAL OF DULUTH

Subdivision Name

Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St - Rheumatology

Type

Rural Referral Center

Rural

Yes

340B ID

RRC240047-17

Medicare Provider Number

240047

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/23/2024

Last Recertification Date

Termination Date
Termination Reason

1/1/2025
Other

Contacts

Authorizing Official

St. Luke's Hospital of Duluth
Michael Boeselager, Vice President Support Services
(218) 249-2459

Primary Contact

St. Luke's Hospital of Duluth
Katherine Becker, Vice President Corporate Compliance
(218) 249-5357

Addresses

Street Address

1000 E 1st St
302
Duluth, MN 55805

Billing Address

St. Luke's Hospital of Duluth
915 E 1st St
Duluth, MN 55805

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MN	1801835970	1801835970

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC240047-01	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Infectious Disease - Infectious Disease	915 E 1st St	Duluth	MN	Terminated
RRC240047-02	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Dermatology - 920 E 1st St - Dermatology	920 E 1st St.	Duluth	MN	Terminated
RRC240047-03	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Duluth Surgery Center - Surgery Center	920 E 1st st	Duluth	MN	Terminated
RRC240047-04	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Diagnostic Imaging - Diagnostic Imaging	1015 E 1st Street	Duluth	MN	Terminated
RRC240047-05	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hermantown Clinic - Family Medicine	4190 Loberg Avenue	Hermantown	MN	Terminated
RRC240047-06	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Urgent Care - Hermantown - Urgent Care	4190 Loberg Avenue	Hermantown	MN	Terminated
RRC240047-07	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Neurosurgery - 1015 E 1st St - Neurosurgery	1015 E 1st St	Duluth	MN	Terminated
RRC240047-08	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	ST LUKES HOSPITAL OF DULUTH - Cancer Care	1001 E SUPERIOR ST	DULUTH	MN	Terminated
RRC240047-09	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	ST LUKES HOSPITAL OF DULUTH - Wound	1000 E 1ST ST	DULUTH	MN	Terminated
RRC240047-10	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	ST LUKES HOSP ASSOC DULUTH - clinic	109 N 28TH ST E	SUPERIOR	WI	Terminated
RRC240047-11	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	ST LUKES HOSPITAL OF DULUTH - Family Medicine	1400 WOODLAND AVE	DULUTH	MN	Terminated
RRC240047-12	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Endocrinology - Endocrinology	1000 E 1st St	Duluth	MN	Terminated
RRC240047-13	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - 6351 E Superior St - Family Medicine Clinic	6351 E Superior St.	Duluth	MN	Terminated
RRC240047-14	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Urology - 1001 E Superior St - Urology	1001 East Superior St.	Duluth	MN	Terminated
RRC240047-15	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Oncology & Hematology - 1001 E Superior St - Oncology	1001 East Superior Street	Duluth	MN	Terminated
RRC240047-16	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Internal Medicine - 1001 E Superior St - Internal Medicine	1001 East Superior St	Duluth	MN	Terminated
RRC240047-17	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St - Rheumatology	1000 E 1st St	Duluth	MN	Terminated
RRC240047-18	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Obstetrics & Gynecology - 1001 E Superior St - OB/GYN	1001 East Superior Street	Duluth	MN	Terminated
RRC240047-19	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Radiation Oncology - 1001 E Superior St - Radiation Oncology	1001 E Superior St.	Duluth	MN	Terminated
RRC240047-20	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - General Surgery - 920 E 1st St - General Surgery	920 E 1st St.	Duluth	MN	Terminated
RRC240047-21	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Hospital Medicine - Hospital Medicine	915 E 1st St	Duluth	MN	Terminated
RRC240047-22	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Neurology 1015 E 1st St - Neurology	1015 E 1st St	Duluth	MN	Terminated
RRC240047-23	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Interventional Pain Management - 1015 E 1st St - Pain Management	1015 E 1st St	Duluth	MN	Terminated
RRC240047-24	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hermantown Clinic - Eye Care - Eye Care	4190 Loberg Avenue	Hermantown	MN	Terminated
RRC240047-25	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Vascular Surgery - 1000 E 1st St - Vascular Surgery	1000 East First Street	Duluth	MN	Terminated
RRC240047-26	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Nephrology - 1000 E 1st St - Nephrology	1000 E 1st St	Duluth	MN	Terminated
RRC240047-27	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Clinical Nutrition - 1000 E 1st St - Clinical Nutrition	1011 E 1st St.	Duluth	MN	Terminated
RRC240047-28	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Ear, Nose & Throat - 920 E 1st St - ENT	920 East First Street	Duluth	MN	Terminated
RRC240047-29	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Emergency Department - ED	1015 E 1st St	Duluth	MN	Terminated
RRC240047-30	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Grand Ave - Family Medicine	4702 Grand Ave	Duluth	MN	Terminated
RRC240047-31	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Cardiac Cath Lab - 1015 E 1st St - Cardiac Cath Lab	1015 E 1st St	Duluth	MN	Terminated
RRC240047-32	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Cardiac and Pulmonary Rehab Gym - Cardiac Rehab	1015 E. 1st Street	Duluth	MN	Terminated
RRC240047-33	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Cardiac Diagnostic Testing - Cardiac Diagnostic Testing	1015 E. 1st Street	Duluth	MN	Terminated
RRC240047-34	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	ST. LUKE'S HOSPITAL INFUSION CLINIC BUILDING A 2ND FLOOR - INFUSION CLINIC BUILDING A 2ND FLOOR - INFUSION CLINIC	1015 E 1st St	Duluth	MN	Terminated
RRC240047-35	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Surgical & Procedural Care 1015 E 1st St - Surgery	1015 E 1st St	Duluth	MN	Terminated
RRC240047-36	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Superior Surgery Center - Surgery Center	109 N 28th St. East	Superior	WI	Terminated
RRC240047-37	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Cardiology - 1001 E Superior St - Cardiology	1001 East Superior St.	Duluth	MN	Terminated
RRC240047-38	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Pulmonary Medicine - 920 E 1st St - Pulmonary	920 E 1st St.	Duluth	MN	Terminated
RRC240047-39	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Cardiothoracic Surgery - 920 E 1st St - Cardiothoracic Surgery	920 E 1st St	Duluth	MN	Terminated
RRC240047-40	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Behavioral Health Clinic - Duluth - Behavioral Health	220 N 6TH Ave. E	Duluth	MN	Terminated
RRC240047-41	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - 26 E Superior St - Family Medicine	26 E Superior St.	Duluth	MN	Terminated
RRC240047-42	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Physical Medicine & Rehab 1015 E 1st St - Physical Med	1012 E 2nd St	Duluth	MN	Terminated
RRC240047-43	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Eye Care - Duluth - Eye Care	324 W Superior St.	Duluth	MN	Terminated
RRC240047-44	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Orthopedics & Sports Medicine - 1015 E 1st St - Orthopedics	1015 E 1st St	Duluth	MN	Terminated
RRC240047-45	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Gastroenterology 1015 E 1st St - Gastroenterology	1015 E 1st St	Duluth	MN	Terminated
RRC240047-46	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Clinic - Duluth - Pediatrics - 1015 E 1st St - Pediatrics	1015 E 1st St	Duluth	MN	Terminated
RRC240047-47	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Diagnostic Imaging - Diagnostic Imaging	1015 E. 1st Street	Duluth	MN	Terminated
RRC240047-48	Child	RRC	ST. LUKES HOSPITAL OF DULUTH	Aspirus St. Luke's Hospital - Diagnostic Imaging - Diagnostic Imaging	1015 E 1st St	Duluth	MN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/17/2024 12:00:00 AM	12/17/2024 10:49 AM
Details	State	Update	Termination Request	Approved	To Be Terminated	12/17/2024 10:49 AM
Terminations	Termination Comments	Update	Termination Request		Met DSH status, so do not need the RRC designation. Terminating RRC240047-00 based on guidance from Josh Volpe in emails 12/17/24 so that DSH240047 can remain effective.	12/17/2024 10:49 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/17/2024 10:49 AM
Terminations	Termination Effective Date	Update	Termination Request		12/17/2024 12:00:00 AM	12/17/2024 10:49 AM
Terminations	Termination Reason	Update	Termination Request		Other	12/17/2024 10:49 AM
Contacts	Signed By	Insert	New Registration		Boeselager, Michael Vice President Support Services St. Luke's Hospital of Duluth 2182492459	10/23/2024 9:25 AM
Details	340B ID	Update	New Registration		RRC240047-17	10/23/2024 9:25 AM
Details	Entity Subname	Update	New Registration	Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St	Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St - Rheumatology	10/23/2024 9:25 AM
Dates	Participating Approval Date	Update	New Registration		10/23/2024 9:25:11 AM	10/23/2024 9:25 AM
Details	State	Update	New Registration	Pending	Approved	10/23/2024 9:25 AM
Dates	Signed By Date	Update	New Registration		10/15/2024 5:23:12 PM	10/23/2024 9:25 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/23/2024 9:25 AM
Addresses	Main Address	Insert	New Registration		1000 E 1st St 302 Duluth, MN 55805	10/15/2024 4:43 PM
Addresses	Billing Address	Insert	New Registration		St. Luke's Hospital of Duluth 915 E 1st St Duluth, MN 55805	10/15/2024 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/15/2024 4:43 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1801835970	10/15/2024 4:43 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	10/15/2024 4:43 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1801835970	10/15/2024 4:43 PM
Medicaid Billing	NPI: State	Insert	New Registration		MN	10/15/2024 4:43 PM
Contacts	Primary Contact	Insert	New Registration		Becker, Katherine Vice President Corporate Compliance St. Luke's Hospital of Duluth 2182495357	10/15/2024 4:43 PM
Contacts	Authorizing Official	Insert	New Registration		Boeselager, Michael Vice President Support Services St. Luke's Hospital of Duluth 2182492459	10/15/2024 4:43 PM
Details	Assistance Received From Date	Insert	New Registration			10/15/2024 4:43 PM
Details	Assistance Received To Date	Insert	New Registration			10/15/2024 4:43 PM
Details	Last Recertification Date	Insert	New Registration			10/15/2024 4:43 PM
Details	Grant Number	Insert	New Registration			10/15/2024 4:43 PM
Details	340B ID	Insert	New Registration			10/15/2024 4:43 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/15/2024 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/15/2024 4:43 PM
Details	Medicare Provider Number	Insert	New Registration		240047	10/15/2024 4:43 PM
Details	Entity Name	Insert	New Registration		ST. LUKES HOSPITAL OF DULUTH	10/15/2024 4:43 PM
Details	NOFO Number	Insert	New Registration			10/15/2024 4:43 PM
Details	Program Code	Insert	New Registration		RRC	10/15/2024 4:43 PM
Details	Entity Subname	Insert	New Registration		Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St	10/15/2024 4:43 PM
Dates	Participating Approval Date	Insert	New Registration			10/15/2024 4:43 PM
Details	State	Insert	New Registration		Pending	10/15/2024 4:43 PM
Dates	Registration Date	Insert	New Registration		10/15/2024 4:43:04 PM	10/15/2024 4:43 PM
Dates	Signed By Date	Insert	New Registration			10/15/2024 4:43 PM
Dates	Start Date	Insert	New Registration			10/15/2024 4:43 PM
Terminations	Termination Comments	Insert	New Registration			10/15/2024 4:43 PM
Terminations	Termination Date	Insert	New Registration			10/15/2024 4:43 PM
Terminations	Termination Effective Date	Insert	New Registration			10/15/2024 4:43 PM
Terminations	Termination Reason	Insert	New Registration			10/15/2024 4:43 PM