340B Drug Pricing Program Database


DSH240002B ST MARYS MEDICAL CENTER (Terminated) - information as of 6/27/2025 12:28:40 AM

Main Details
ST MARYS MEDICAL CENTER
Essentia Health St. Marys Medical Center / Anesthesia
Disproportionate Share Hospital
Yes
DSH240002B
240002


Additional Details
Terminated
1/9/2018
4/1/2018
1/25/2018
8/29/2023

10/1/2024
Change of covered entity type

Contacts

Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652

Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246

Addresses

420 E 1ST ST
DULUTH, MN 55805

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MN 1457393035
WI 1457393035
MI 1457393035
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH240002AChildDSHST MARYS MEDICAL CENTEREssentia Health St. Marys Medical Center / Endoscopy420 E 1ST STDULUTHMNTerminated
DSH240002BChildDSHST MARYS MEDICAL CENTEREssentia Health St. Marys Medical Center / Anesthesia420 E 1ST STDULUTHMNTerminated
DSH240002CChildDSHST MARYS MEDICAL CENTEREssentia Health Duluth Clinic / - Pulmonary Function Lab400 E 3RD STREETDULUTHMNTerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated10/1/2024 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 10/1/2024 12:00:00 AM7/31/2024 12:36 PM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated7/31/2024 12:36 PM
TerminationsTermination DateUpdateHospital Type Change Request 10/1/2024 12:00:00 AM7/31/2024 12:36 PM
TerminationsTermination Effective DateUpdateHospital Type Change Request 10/1/2024 12:00:00 AM7/31/2024 12:36 PM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type7/31/2024 12:36 PM
ContactsPrimary ContactUpdateGroup Change RequestBrooks-Dockendorf, Rhonda 340B Program Coordinator Essentia Health 2187864423Sharrow, Nick Pharmacy Business Services Director Essentia Health 21860692462/27/2024 1:02 PM
ContactsPrimary ContactUpdateGroup Change RequestSedlachek, Andrea 340B Senior Coordinator Essentia Health 2183936699Brooks-Dockendorf, Rhonda 340B Program Coordinator Essentia Health 218786442311/7/2023 9:06 AM
DetailsLast Recertification DateUpdateRecertification9/5/2022 9:18:01 AM8/29/2023 10:51:43 AM8/29/2023 10:51 AM
ContactsPrimary ContactUpdatePC Change RequestOlivier, Ryan Pharmacy 340B Manager Essentia Health 2185760677Sedlachek, Andrea 340B Senior Coordinator Essentia Health 21839366995/25/2023 9:31 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 3:34:18 PM9/5/2022 9:18:01 AM9/5/2022 9:18 AM
ContactsPrimary ContactUpdateGroup Change RequestKaufenberg, Anthony Vice President, Pharmacy Essentia Health 2188287693Olivier, Ryan Pharmacy 340B Manager Essentia Health 21857606779/13/2021 7:43 AM
DetailsLast Recertification DateUpdateRecertification8/25/2020 9:33:32 AM9/9/2021 3:34:18 PM9/9/2021 3:34 PM
ContactsPrimary ContactUpdateGroup Change RequestHeide, Dawn 340B Senior Program Coordinator Essentia Health 2188287143Kaufenberg, Anthony Vice President, Pharmacy Essentia Health 21882876937/8/2021 4:04 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (ND) 4/8/2021 4:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (SD) 4/8/2021 4:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (IA) 4/8/2021 4:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (IL) 4/8/2021 4:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (NY) 4/8/2021 4:31 PM
Medicaid BillingNPI: NumberDeleteChange Request1457393035 (CA) 4/8/2021 4:31 PM
ContactsPrimary ContactUpdateChange RequestLundberg, Bryan 340b Program Manager Essentia Health 2188287143Heide, Dawn 340B Senior Program Coordinator Essentia Health 21882871431/25/2021 10:40 AM
ContactsPrimary ContactUpdateProfile Change RequestLundberg, Bryan 340b Program Manager Essentia Health 2185760745Lundberg, Bryan 340b Program Manager Essentia Health 218828714310/9/2020 9:19 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification WI8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification MI8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification ND8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification SD8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification IA8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification IL8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification NY8/25/2020 9:33 AM
Medicaid BillingNPI: NumberInsertRecertification 14573930358/25/2020 9:33 AM
Medicaid BillingNPI: StateInsertRecertification CA8/25/2020 9:33 AM
Medicaid BillingNPI: StateUpdateRecertification MN8/25/2020 9:33 AM
DetailsLast Recertification DateUpdateRecertification8/29/2019 10:03:21 AM8/25/2020 9:33:32 AM8/25/2020 9:33 AM
ContactsPrimary ContactUpdateProfile Change RequestLundberg, Bryan 340b Program Manager Essentia 2185760745Lundberg, Bryan 340b Program Manager Essentia Health 21857607454/1/2020 10:07 AM
AddressesMain AddressUpdateChange Request 420 EAST FIRST STREET Duluth, MN 55805 420 E 1ST ST DULUTH, MN 558051/28/2020 4:07 PM
DetailsEntity SubnameUpdateChange RequestEssentia Health St. Marys Medical Center - AnesthesiaEssentia Health St. Marys Medical Center / Anesthesia1/28/2020 4:07 PM
DetailsLast Recertification DateUpdateRecertification9/7/2018 3:10:18 PM8/29/2019 10:03:21 AM8/29/2019 10:03 AM
ContactsAuthorizing OfficialUpdateChange RequestGarvey, James M. SVP Hospital Operations East Region Essentia Health 2187864878Beard, Bradley Chief Operating Officer Essentia Health 21878626528/1/2019 12:11 AM
DetailsLast Recertification DateUpdateRecertification 9/7/2018 3:10:18 PM9/7/2018 3:10 PM
DetailsStateUpdate ApprovedActive4/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Garvey, James M. SVP Hospital Operations East Region Essentia Health 21878648781/25/2018 8:54 AM
Details340B IDUpdateNew Registration DSH240002B1/25/2018 8:54 AM
DetailsEntity SubnameUpdateNew RegistrationEssentia Health St. Marys Medical CenterEssentia Health St. Marys Medical Center - Anesthesia1/25/2018 8:54 AM
DatesParticipating Approval DateUpdateNew Registration 1/25/2018 8:54:15 AM1/25/2018 8:54 AM
DetailsStateUpdateNew RegistrationPendingApproved1/25/2018 8:54 AM
DatesSigned By DateUpdateNew Registration 1/12/2018 11:05:28 AM1/25/2018 8:54 AM
DatesStart DateUpdateNew Registration 4/1/2018 12:00:00 AM1/25/2018 8:54 AM
AddressesMain AddressInsertNew Registration  420 EAST FIRST STREET Duluth, MN 558051/9/2018 3:48 PM
Medicaid BillingNPI: NumberInsertNew Registration 14573930351/9/2018 3:48 PM
ContactsAuthorizing OfficialInsertNew Registration Garvey, James M. SVP Hospital Operations East Region Essentia Health 21878648781/9/2018 3:48 PM
ContactsPrimary ContactInsertNew Registration Lundberg, Bryan 340b Program Manager Essentia 21857607451/9/2018 3:48 PM
DetailsLast Recertification DateInsertNew Registration  1/9/2018 3:48 PM
DetailsGrant NumberInsertNew Registration  1/9/2018 3:48 PM
Details340B IDInsertNew Registration  1/9/2018 3:48 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/9/2018 3:48 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/9/2018 3:48 PM
DetailsMedicare Provider NumberInsertNew Registration 2400021/9/2018 3:48 PM
DetailsEntity NameInsertNew Registration ST. MARY'S MEDICAL CENTER1/9/2018 3:48 PM
DetailsProgram CodeInsertNew Registration DSH1/9/2018 3:48 PM
DetailsEntity SubnameInsertNew Registration Essentia Health St. Marys Medical Center1/9/2018 3:48 PM
DatesParticipating Approval DateInsertNew Registration  1/9/2018 3:48 PM
DetailsStateInsertNew Registration Pending1/9/2018 3:48 PM
DatesRegistration DateInsertNew Registration 1/9/2018 3:48:50 PM1/9/2018 3:48 PM
DatesSigned By DateInsertNew Registration  1/9/2018 3:48 PM
DatesStart DateInsertNew Registration  1/9/2018 3:48 PM
TerminationsTermination CommentsInsertNew Registration  1/9/2018 3:48 PM
TerminationsTermination DateInsertNew Registration  1/9/2018 3:48 PM
TerminationsTermination Effective DateInsertNew Registration  1/9/2018 3:48 PM
TerminationsTermination ReasonInsertNew Registration  1/9/2018 3:48 PM