Covered Entity Details

CAH241321-01 HOLY TRINITY HOSPITAL (Terminated) - information as of 6/4/2025 12:03:09 PM

Main Details

Name

HOLY TRINITY HOSPITAL

Subdivision Name

GRACEVILLE HEALTH CENTER CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH241321-01

Medicare Provider Number

241321

Outpatient Facility Provider Number

243997

Additional Details

Current Program Status

Terminated

Registration Date

9/16/2010

Participating Start Date

9/16/2010

Participating Approval Date

9/16/2010

Last Recertification Date

9/4/2015

Termination Date
Termination Reason

10/1/2015
Other

Contacts

Authorizing Official

Essentia Health
Julie Rosenberg, Administrator
(320) 748-8203

Primary Contact

Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 576-0745

Addresses

Street Address

115 W. 2ND STREET
GRACEVILLE, MN 56240

Billing Address

HOLY TRINITY HOSPITAL
PO BOX 157
GRACEVILLE, MN 56240

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
		1013976281

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
CAH241321-01	Child	CAH	HOLY TRINITY HOSPITAL	GRACEVILLE HEALTH CENTER CLINIC	115 W. 2ND STREET	GRACEVILLE	MN	Terminated
CAH241321-02	Child	CAH	GRACEVILLE HEALTH CENTER	ESSENTIA HEALTH CHOKIO CLINIC / FAMILY PRACTICE	101 MAIN STREET	CHOKIO	MN	Terminated
CAH241321-03	Child	CAH	HOLY TRINITY HOSPITAL	GRACEVILLE HEALTH CENTER HOME HEALTH	115 W. 2ND STREET	GRACEVILLE	MN	Terminated
CAH241321-04	Child	CAH	GRACEVILLE HEALTH CENTER	Essentia Health Graceville Clinic / Family Practice	117 W 2nd Street	Graceville	MN	Terminated
CAH241321-05	Child	CAH	GRACEVILLE HEALTH CENTER	Essentia Health Graceville Clinic / Podiatry	117 W 2nd Street	Graceville	MN	Terminated
CAH241321-06	Child	CAH	GRACEVILLE HEALTH CENTER	Essentia Health Graceville Clinic / Urology	117 W 2nd Street	Graceville	MN	Terminated

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Rosenberg, Julie Administrator 3207488203	Rosenberg, Julie Administrator Essentia Health 3207488203	9/22/2017 10:26 AM
Contacts	Primary Contact	Update	Lundberg, Bryan 340b Program Manager 2185760745	Lundberg, Bryan 340b Program Manager Essentia Health 2185760745	9/20/2017 2:58 PM
Contacts	Authorizing Official	Update	Campion, John CEO 3207488203	Rosenberg, Julie Administrator 3207488203	9/11/2017 3:29 PM
Contacts	Primary Contact	Update	MESSMER, CHET PHARMACIST 3207488217	Lundberg, Bryan 340b Program Manager 2185760745	8/11/2017 2:26 PM
Contacts	Authorizing Official	Update	GISH, KEVIN CEO 3207487223	Campion, John CEO 3207488203	1/30/2017 4:23 PM
Details	Last Recertification Date	Update	8/8/2014 12:00:00 AM	9/4/2015 12:00:00 AM	9/4/2015 7:07 AM
Dates	Last Date That 340B Drugs Purchased	Update		9/3/2015 12:00:00 AM	9/4/2015 7:07 AM
Details	State	Update	Active	Terminated	9/4/2015 7:07 AM
Terminations	Termination Comments	Update		I am terminating the Child Site due to it having the same physical address as Parent Site. According to Apexus/HRSA we do not need it registered on the database. This Child Site would remain eligible as it is considered within the 4 walls of the hospital.	9/4/2015 7:07 AM
Terminations	Termination Date	Update		10/1/2015 12:00:00 AM	9/4/2015 7:07 AM
Terminations	Termination Effective Date	Update		9/3/2015 12:00:00 AM	9/4/2015 7:07 AM
Terminations	Termination Reason	Update		Other	9/4/2015 7:07 AM
Addresses	Main Address	Insert		115 W. 2ND STREET GRACEVILLE, MN 56240	9/4/2015 7:07 AM
Details	Last Recertification Date	Update	9/13/2013 12:00:00 AM	8/8/2014 12:00:00 AM	8/8/2014 3:35 PM
Addresses	Billing Address	Insert		HOLY TRINITY HOSPITAL PO BOX 157 GRACEVILLE, MN 56240	7/31/2014 3:56 PM
Contacts	Primary Contact	Insert		MESSMER, CHET PHARMACIST 3207488217	7/22/2014 11:24 AM
Contacts	Authorizing Official	Update	HOWELL, TODD ADMINISTRATOR 3207487223	GISH, KEVIN CEO 3207487223	7/3/2014 4:20 PM
Details	Last Recertification Date	Update	7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 2:04 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	6/27/2012 7:11 AM
Contacts	Authorizing Official	Insert		HOWELL, TODD ADMINISTRATOR 3207487223	9/16/2010 2:30 PM
Details	Last Recertification Date	Insert			9/16/2010 2:30 PM
Details	Grant Number	Insert			9/16/2010 2:30 PM
Details	340B ID	Insert		CAH241321-01	9/16/2010 2:30 PM
Details	Is Authorizing Official EHB Data	Insert			9/16/2010 2:30 PM
Dates	Last Date That 340B Drugs Purchased	Insert			9/16/2010 2:30 PM
Details	Medicare Provider Number	Insert		241321	9/16/2010 2:30 PM
Details	Entity Name	Insert		HOLY TRINITY HOSPITAL	9/16/2010 2:30 PM
Details	Program Code	Insert		CAH	9/16/2010 2:30 PM
Details	Entity Subname	Insert		GRACEVILLE HEALTH CENTER CLINIC	9/16/2010 2:30 PM
Dates	Participating Approval Date	Insert		9/16/2010 12:00:00 AM	9/16/2010 2:30 PM
Details	State	Insert		Active	9/16/2010 2:30 PM
Dates	Registration Date	Insert		9/16/2010 12:00:00 AM	9/16/2010 2:30 PM
Dates	Signed By Date	Insert		9/15/2010 12:00:00 AM	9/16/2010 2:30 PM
Dates	Start Date	Insert		9/16/2010 12:00:00 AM	9/16/2010 2:30 PM
Terminations	Termination Comments	Insert			9/16/2010 2:30 PM
Terminations	Termination Date	Insert			9/16/2010 2:30 PM
Terminations	Termination Effective Date	Insert			9/16/2010 2:30 PM
Terminations	Termination Reason	Insert			9/16/2010 2:30 PM
Medicaid Billing	NPI: Number	Insert		1013976281	9/16/2010 10:58 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Parent/Child

History