Covered Entity Details

DSH240075M ST. JOSEPHS MEDICAL CENTER (Terminated) - information as of 5/27/2025 2:41:05 PM

Main Details

Name

ST. JOSEPHS MEDICAL CENTER

Subdivision Name

ESSENTIA HEALTH ST. JOSEPH'S EMILY CLINIC / Family Practice

Type

Disproportionate Share Hospital

Rural

340B ID

DSH240075M

Medicare Provider Number

240075

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/15/2015

Participating Start Date

1/1/2016

Participating Approval Date

11/4/2015

Last Recertification Date

9/1/2016

Termination Date
Termination Reason

1/1/2018
DSH percentage below statutory minimum

Contacts

Authorizing Official

Essentia Health
David Pilot, CFO
(218) 828-7642

Primary Contact

Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143

Addresses

Street Address

20918 COUNTY ROAD 1
EMILY, MN 56447-4045

Billing Address
Same as Street Address

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
		1568415974,1538571914

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
DSH240075A	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PIERZ CL / Anticoagulation Mgmt	221 N MAIN ST	PIERZ	MN	Terminated
DSH240075AA	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / General Internal Medicine	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AB	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Primary Care Psych	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AC	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Neurology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AD	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / General Surgery	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AE	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Podiatry	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AF	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / ENT	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AG	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Anticoagulation Management	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AH	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Family/General Practice	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AJ	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Audiology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AK	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Diabetes Center	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AL	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTER / Outpatient Treatment	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075AM	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Orthopedic Surgery	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AN	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Pain Management	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075AP	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Nephrology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075B	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PIERZ CLINIC / FAMILY PRACTICE	221 N MAIN ST	PIERZ	MN	Terminated
DSH240075BL	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / EEG/Neurdiagnostics	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075BM	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Allergy/Antigen	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075BN	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Outpatient Treatment - Immunization	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075C	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PEQUOT / Anticoagulation Mgmt	4317 W WOODMAN ST	PEQUOT LAKES	MN	Terminated
DSH240075D	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PEQUOT LAKES CLINIC / Family Practice	4317 W WOODMAN ST	PEQUOT LAKES	MN	Terminated
DSH240075E	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PINE RIVER CLINIC / Family Practice	415 BARCLAY AVE	PINE RIVER	MN	Terminated
DSH240075F	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PINE RIV / Anticoagulation Mgmt	415 BARCLAY AVE	PINE RIVER	MN	Terminated
DSH240075G	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS CROSSLAK / Anticoagulation Mgmt	35205 COUNTY RD 3	CROSSLAKE	MN	Terminated
DSH240075H	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS CROSSLAKE CLINIC / Family Practice	35205 COUNTY RD 3	CROSSLAKE	MN	Terminated
DSH240075J	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PILLAGER / Anticoagulation Management	680 PILLSBURY ST N	PILLAGER	MN	Terminated
DSH240075K	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-PILLAGER CLINIC / Family Practice	680 PILLSBURY ST N	PILLAGER	MN	Terminated
DSH240075L	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-LAKES UR / Urology	1903 S 6TH ST	BRAINERD	MN	Terminated
DSH240075M	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST. JOSEPH'S EMILY CLINIC / Family Practice	20918 COUNTY ROAD 1	EMILY	MN	Terminated
DSH240075N	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTE / General Pediatrics	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075P	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTE / OB & Gynecology	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075Q	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTE / Urgent Care	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075R	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTE / Anticoagulation Management	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075S	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH - ST JOSEPH'S BAXTE / Family Practice	13060 ISLE DRIVE	BAXTER	MN	Terminated
DSH240075T	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Cardiology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075U	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Endocrinology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075V	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Gastroenterology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075W	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Hemotology/Oncology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075X	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Pulmonary Disease	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075Y	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Rheumatology	2024 S 6TH ST	BRAINERD	MN	Terminated
DSH240075Z	Child	DSH	ST. JOSEPHS MEDICAL CENTER	ESSENTIA HEALTH ST JOSEPHS-BRAINERD / Allergy	2024 S 6TH ST	BRAINERD	MN	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Lundberg, Bryan 340b Program Manager Essentia Health 2185760745	Lundberg, Bryan 340b Program Manager Essentia Health 2188287143	10/9/2020 9:19 AM
Contacts	Primary Contact	Update	Profile Change Request	Lundberg, Bryan 340b Program Manager Essentia 2185760745	Lundberg, Bryan 340b Program Manager Essentia Health 2185760745	4/1/2020 10:07 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		11/29/2017 12:00:00 AM	11/30/2017 4:20 PM
Details	State	Update	Recertification	Active	To Be Terminated	11/30/2017 4:20 PM
Terminations	Termination Comments	Update	Recertification		DSH percentage below statutory minimum for most recent cost report. Will re-register as a Sole Community Hospital on 1/01/2018.	11/30/2017 4:20 PM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	11/30/2017 4:20 PM
Terminations	Termination Effective Date	Update	Recertification		11/30/2017 12:00:00 AM	11/30/2017 4:20 PM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	11/30/2017 4:20 PM
Contacts	Authorizing Official	Update		Pilot, David CFO 2188287642	Pilot, David CFO Essentia Health 2188287642	9/28/2017 3:01 PM
Contacts	Signed By	Update		Pilot, David CFO 2188287642	Pilot, David CFO Essentia Health 2188287642	9/28/2017 3:01 PM
Contacts	Primary Contact	Update		Lundberg, Bryan 340b Program Manager 2185760745	Lundberg, Bryan 340b Program Manager Essentia 2185760745	9/20/2017 3:06 PM
Contacts	Primary Contact	Insert			Lundberg, Bryan 340b Program Manager 2185760745	8/14/2017 1:06 PM
Contacts	Authorizing Official	Insert			Pilot, David CFO 2188287642	8/11/2017 11:42 AM
Contacts	Signed By	Insert			Pilot, David CFO 2188287642	8/11/2017 11:42 AM
Addresses	Main Address	Insert			20918 COUNTY ROAD 1 EMILY, MN 56447-4045	2/21/2017 5:35 PM
Details	Entity Subname	Update		ESSENTIA HEALTH ST. JOSEPH'S EMILY / Emily Clinic	ESSENTIA HEALTH ST. JOSEPH'S EMILY CLINIC / Family Practice	1/17/2017 9:45 AM
Details	Last Recertification Date	Update			9/1/2016 12:00:00 AM	9/1/2016 10:24 AM
Medicaid Billing	NPI: Number	Insert			1538571914	3/10/2016 7:11 PM
Dates	Participating Approval Date	Update			11/4/2015 12:00:00 AM	11/4/2015 11:34 AM
Details	State	Update		Pending	Active	11/4/2015 11:34 AM
Dates	Start Date	Update			1/1/2016 12:00:00 AM	11/4/2015 11:34 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_55984	DSH240075M	10/23/2015 1:19 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_55984	10/15/2015 1:22 PM
Medicaid Billing	NPI: Number	Insert			1568415974	10/15/2015 1:22 PM
Details	Last Recertification Date	Insert				10/15/2015 1:22 PM
Details	Grant Number	Insert				10/15/2015 1:22 PM
Details	340B ID	Insert				10/15/2015 1:22 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2015 1:22 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2015 1:22 PM
Details	Medicare Provider Number	Insert			240075	10/15/2015 1:22 PM
Details	Entity Name	Insert			ST. JOSEPHS MEDICAL CENTER	10/15/2015 1:22 PM
Details	Program Code	Insert			DSH	10/15/2015 1:22 PM
Details	Entity Subname	Insert			ESSENTIA HEALTH ST. JOSEPH'S EMILY / Emily Clinic	10/15/2015 1:22 PM
Dates	Participating Approval Date	Insert				10/15/2015 1:22 PM
Details	State	Insert			Pending	10/15/2015 1:22 PM
Dates	Registration Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 1:22 PM
Dates	Signed By Date	Insert			10/15/2015 12:00:00 AM	10/15/2015 1:22 PM
Dates	Start Date	Insert				10/15/2015 1:22 PM
Terminations	Termination Comments	Insert				10/15/2015 1:22 PM
Terminations	Termination Date	Insert				10/15/2015 1:22 PM
Terminations	Termination Effective Date	Insert				10/15/2015 1:22 PM
Terminations	Termination Reason	Insert				10/15/2015 1:22 PM