Covered Entity Details

RRC350070-29 INNOVIS HEALTH (Active) - information as of 5/3/2025 11:27:32 PM

Main Details

Name

INNOVIS HEALTH

Subdivision Name

INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / General Surgery - MHD

Type

Rural Referral Center

Rural

Yes

340B ID

RRC350070-29

Medicare Provider Number

350070

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/17/2022

Participating Start Date

4/1/2022

Participating Approval Date

1/25/2022

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

Essentia Health
Al Hurley, COO
(701) 364-7667

Primary Contact

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

Addresses

Street Address

801 BELSLY BLVD
MOORHEAD, MN 56560-5055

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?
No

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
RRC350070-01	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / General Pediatrics	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-02	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Skin Renewal Clinic	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-03	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Allergy	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-04	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Rheumatology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-05	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Audiology	1702 UNIVERSITY DR S	FARGO	ND	Terminated
RRC350070-06	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Genetic Counseling	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-07	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Sleep Medicine	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-08	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST FARGO CLINIC / Occupational Medicine - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-09	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Pain Management	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-10	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Hematology-Oncology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-11	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Radiation Oncology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-12	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Physical Med and Rehab	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-13	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH 52ND AVENUE CLINIC / Family Practice - 52ND AVE	4110 51ST AVE S	FARGO	ND	Active
RRC350070-14	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Dermatology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-15	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Pulmonary Function Lab	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-16	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Diabetes Center	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-17	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Pulmonary Disease	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-18	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Ear Nose and Throat	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-19	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Anticoagulation Mgmt	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-20	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - Essentia Health South University Clinic / Endocrinology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-21	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Gen Internal Medicine	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-22	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Behav Hlth Ref Ctr	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-23	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / General Surgery	1702 UNIVERSITY DR S	FARGO	ND	Terminated
RRC350070-24	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Podiatry	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-25	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Ophthalmology	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-26	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Family Practice	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-27	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Ambulatory Infusion Ctr	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-28	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Sleep Lab	1702 UNIVERSITY DR S	FARGO	ND	Active
RRC350070-29	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / General Surgery - MHD	801 BELSLY BLVD	MOORHEAD	MN	Active
RRC350070-30	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / Family Practice - MHD	801 BELSLY BLVD	MOORHEAD	MN	Active
RRC350070-31	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST ACRES CLINIC / Walk-In Clinic - WA	3902 13TH AVE S	FARGO	ND	Active
RRC350070-32	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST ACRES CLINIC / Family Practice - WA	3902 13TH AVE S	FARGO	ND	Active
RRC350070-33	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST FARGO CLINIC / Walk-In Clinic - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-34	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST FARGO CLINIC / Family Practice - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-35	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH WEST FARGO CLINIC / Integrative Health - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-36	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH 52ND AVENUE CLINIC / Walk-In Clinic - 52ND AVE	4110 51ST AVE S	FARGO	ND	Active
RRC350070-37	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Pediatric Oncology - INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Pediatric Oncology	1702 SOUTH UNIVERSITY DRIVE	Fargo	ND	Active
RRC350070-38	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / Medication Therapy Mgmt - INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / Medication Therapy Mgmt	801 BELSLY BOULEVARD	Moorhead	MN	Active
RRC350070-39	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Psychology - INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / Psychology	1702 SOUTH UNIVERSITY DRIVE	Fargo	MN	Active
RRC350070-40	Child	RRC	INNOVIS HEALTH	INNOVIS HEALTH, LLC - ESSENTIA HEALTH CASSELTON CLINIC / Family Practice - INNOVIS HEALTH, LLC - ESSENTIA HEALTH CASSELTON CLINIC / Family Practice	5 9th Avenue North	Casselton	ND	Active
RRC350070-41	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST ACRES CLINIC / - Endocrinology	3902 13TH AVE S	Fargo	ND	Active
RRC350070-42	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / - General Radiology	1702 South University Drive	Fargo	ND	Active
RRC350070-43	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST FARGO CLINIC / - General Radiology - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-44	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH MOORHEAD CLINIC / - Behav Hlth Ref Ctr	801 BELSLY BLVD	MOORHEAD	MN	Active
RRC350070-45	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH MOORHEAD CLINIC / - General Radiology - MHD	801 BELSLY BOULEVARD	MOORHEAD	MN	Active
RRC350070-46	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH THE LIGHTS WEST FARGO CLINIC / - General Pediatrics - THE LIGHT	3150 SHEYENNE STREET; STE 240	WEST FARGO	ND	Active
RRC350070-47	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH 52ND AVENUE CLINIC / - General Radiology - 52ND AVE	4110 51ST AVE S	FARGO	ND	Active
RRC350070-48	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH 52ND AVENUE CLINIC / - 24 7 Virtual Care - 52ND AVE	4110 51ST AVE S	FARGO	ND	Active
RRC350070-49	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH THE LIGHTS WEST FARGO CLINIC / - OB and Gynecology - THE LIGHTS	3150 SHEYENNE STREET; STE 240	WEST FARGO	ND	Active
RRC350070-50	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST ACRES CLINIC / - General Pediatrics	3902 13TH AVE S	Fargo	ND	Active
RRC350070-51	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH MOORHEAD CLINIC / - Podiatry	801 Belsly Boulevard	Moorhead	MN	Active
RRC350070-52	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST FARGO CLINIC / - OB and Gynecology	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-53	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST FARGO CLINIC / - Medication Therapy Mgmt - WF	1401 13TH AVE E	WEST FARGO	ND	Active
RRC350070-54	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH THE LIGHTS WEST FARGO CLINIC / - Family Practice - THE LIGHTS	3150 SHEYENNE STREET; STE 240	WEST FARGO	ND	Active
RRC350070-55	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST ACRES CLINIC / - OB and Gynecology	3902 13TH AVE S	Fargo	ND	Active
RRC350070-56	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / - Elder Care	1702 SOUTH UNIVERSITY DRIVE	FARGO	ND	Active
RRC350070-57	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / - Rad Oncology Ancillary	1702 SOUTH UNIVERSITY DRIVE	FARGO	ND	Active
RRC350070-58	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST ACRES CLINIC / - Podiatry	3902 13TH AVE S	Fargo	ND	Active
RRC350070-59	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST ACRES CLINIC / - General Radiology - WA	3902 13TH AVE S	Fargo	ND	Active
RRC350070-60	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH CASSELTON CLINIC / - General Radiology - CS	5 9th Avenue North	Casselton	ND	Active
RRC350070-61	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH THE LIGHTS WEST FARGO CLINIC / - General Radiology - THE LIGHTS	3150 SHEYENNE STREET; STE 240	WEST FARGO	ND	Active
RRC350070-62	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH WEST FARGO CLINIC / - Endocrinology	1401 13TH AVE E	West Fargo	ND	Active
RRC350070-63	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH MOORHEAD CLINIC / - Pain Management	801 BELSLY BOULEVARD	MOORHEAD	MN	Active
RRC350070-64	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH 45TH STREET CLINIC / - Walk-In Clinic - 45TH ST	4476 31st Ave S	FARGO	ND	Active
RRC350070-65	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH 45TH STREET CLINIC / - Family Practice - 45TH ST	4476 31st Ave S	FARGO	ND	Active
RRC350070-66	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH THE LIGHTS WEST FARGO CLINIC / - Pediatric Cardiology - THE LIG	3150 SHEYENNE ST	WEST FARGO	ND	Active
RRC350070-67	Child	RRC	INNOVIS HEALTH	ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / - Dietitian	1702 UNIVERSITY DR S	FARGO	ND	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 8:59:17 AM	9/9/2024 11:38:24 AM	9/9/2024 11:38 AM
Contacts	Primary Contact	Update	Group Change Request	Brooks-Dockendorf, Rhonda 340B Program Coordinator Essentia Health 2187864423	Sharrow, Nick Pharmacy Business Services Director Essentia Health 2186069246	3/8/2024 2:27 PM
Contacts	Primary Contact	Update	Group Change Request	Sedlachek, Andrea 340B Senior Coordinator Essentia Health 2183936699	Brooks-Dockendorf, Rhonda 340B Program Coordinator Essentia Health 2187864423	11/8/2023 7:06 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 8:58:52 AM	8/15/2023 8:59:17 AM	8/15/2023 8:59 AM
Contacts	Primary Contact	Update	PC Change Request	Olivier, Ryan Pharmacy 340B Manager Essentia Health 2185760677	Sedlachek, Andrea 340B Senior Coordinator Essentia Health 2183936699	6/5/2023 6:25 AM
Details	Last Recertification Date	Update	Recertification		9/14/2022 8:58:52 AM	9/14/2022 8:58 AM
Details	State	Update		Approved	Active	4/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Hurley, Al COO Essentia Health 7013647667	1/25/2022 10:55 AM
Details	340B ID	Update	New Registration		RRC350070-29	1/25/2022 10:55 AM
Details	Entity Subname	Update	New Registration	INNOVIS HEALTH, LLC	INNOVIS HEALTH, LLC - ESSENTIA HEALTH MOORHEAD CLINIC / General Surgery - MHD	1/25/2022 10:55 AM
Dates	Participating Approval Date	Update	New Registration		1/25/2022 10:55:47 AM	1/25/2022 10:55 AM
Details	State	Update	New Registration	Pending	Approved	1/25/2022 10:55 AM
Dates	Signed By Date	Update	New Registration		1/21/2022 6:50:40 PM	1/25/2022 10:55 AM
Dates	Start Date	Update	New Registration		4/1/2022 12:00:00 AM	1/25/2022 10:55 AM
Addresses	Main Address	Insert	New Registration		801 BELSLY BLVD MOORHEAD, MN 56560-5055	1/17/2022 10:14 PM
Contacts	Primary Contact	Insert	New Registration		Olivier, Ryan Pharmacy 340B Manager Essentia Health 2185760677	1/17/2022 10:14 PM
Contacts	Authorizing Official	Insert	New Registration		Hurley, Al COO Essentia Health 7013647667	1/17/2022 10:14 PM
Details	Assistance Received From Date	Insert	New Registration			1/17/2022 10:14 PM
Details	Assistance Received To Date	Insert	New Registration			1/17/2022 10:14 PM
Details	Last Recertification Date	Insert	New Registration			1/17/2022 10:14 PM
Details	Grant Number	Insert	New Registration			1/17/2022 10:14 PM
Details	340B ID	Insert	New Registration			1/17/2022 10:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/17/2022 10:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/17/2022 10:14 PM
Details	Medicare Provider Number	Insert	New Registration		350070	1/17/2022 10:14 PM
Details	Entity Name	Insert	New Registration		INNOVIS HEALTH	1/17/2022 10:14 PM
Details	NOFO Number	Insert	New Registration			1/17/2022 10:14 PM
Details	Program Code	Insert	New Registration		RRC	1/17/2022 10:14 PM
Details	Entity Subname	Insert	New Registration		INNOVIS HEALTH, LLC	1/17/2022 10:14 PM
Dates	Participating Approval Date	Insert	New Registration			1/17/2022 10:14 PM
Details	State	Insert	New Registration		Pending	1/17/2022 10:14 PM
Dates	Registration Date	Insert	New Registration		1/17/2022 10:14:24 PM	1/17/2022 10:14 PM
Dates	Signed By Date	Insert	New Registration			1/17/2022 10:14 PM
Dates	Start Date	Insert	New Registration			1/17/2022 10:14 PM
Terminations	Termination Comments	Insert	New Registration			1/17/2022 10:14 PM
Terminations	Termination Date	Insert	New Registration			1/17/2022 10:14 PM
Terminations	Termination Effective Date	Insert	New Registration			1/17/2022 10:14 PM
Terminations	Termination Reason	Insert	New Registration			1/17/2022 10:14 PM