Covered Entity Details

DSH240047BE St. Luke's Hospital of Duluth (Active) - information as of 4/29/2025 12:33:24 AM

Main Details

Name

St. Luke's Hospital of Duluth

Subdivision Name

ST. LUKE'S HOSPITAL INFUSION CLINIC BUILDING A 2ND FLOOR - INFUSION CLINIC BUILDING A 2ND FLOOR

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH240047BE

Medicare Provider Number

240047

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2023

Participating Start Date

7/1/2023

Participating Approval Date

5/24/2023

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

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

Primary Contact

Aspirus, Inc.
Stacy Kolz, 340B Pharmacy Program Supervisor
(715) 610-4236

Addresses

Street Address

1012 E. 2ND STREET
DULUTH, MN 55802

Billing Address

ST. LUKE'S HOSPITAL OF DULUTH
915 EAST FIRST STREET
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?
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
DSH240047A	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Cancer Care - Duluth	1001 E Superior St.	Duluth	MN	Active
DSH240047AA	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Endocrinology	1000 E 1st St.	Duluth	MN	Active
DSH240047AB	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - 6351 E Superior St	6351 E Superior St.	Duluth	MN	Active
DSH240047AC	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Urology - 1001 E Superior St	1001 East Superior St.	Duluth	MN	Active
DSH240047AD	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Oncology & Hematology - 1001 E Superior St	1001 East Superior Street	Duluth	MN	Active
DSH240047AE	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Internal Medicine - 1001 E Superior St	1001 East Superior St.	Duluth	MN	Active
DSH240047AF	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Infectious Disease	920 East First Street	Duluth	MN	Active
DSH240047AG	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Rheumatology - 1000 E 1st St	1000 E 1st St.	Duluth	MN	Active
DSH240047AH	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Obstetrics & Gynecology - 1001 E Superior St	1001 East Superior Street	Duluth	MN	Active
DSH240047AJ	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Urgent Care - Hermantown	4190 Loberg Avenue	Hermantown	MN	Active
DSH240047AK	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Radiation Oncology - 1001 E Superior St	1001 E Superior St.	Duluth	MN	Active
DSH240047AL	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - General Surgery - 920 E 1st St	920 E 1st St.	Duluth	MN	Active
DSH240047AM	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Hospital Medicine	1001 East Superior St.	Duluth	MN	Active
DSH240047AN	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Neurology 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047AP	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Diagnostic Imaging	1015 E 1st St	Duluth	MN	Active
DSH240047AQ	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Wound Care & Hyperbaric Center - 1000 E 1st St	1000 East First Street	Duluth	MN	Active
DSH240047AR	Child	DSH	St. Luke's Hospital of Duluth	Q Care - Mount Royal Medical Clinic	1400 Woodland Ave	Duluth	MN	Active
DSH240047AS	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Interventional Pain Management - 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047AT	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hermantown Clinic - Eye Care	4190 Loberg Avenue	Hermantown	MN	Active
DSH240047AU	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Vascular Surgery - 1000 E 1st St	1000 East First Street	Duluth	MN	Active
DSH240047AV	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Nephrology - 1000 E 1st St	1000 E 1st St	Duluth	MN	Active
DSH240047AW	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Clinical Nutrition - 1000 E 1st St	1011 E 1st St.	Duluth	MN	Active
DSH240047AX	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Ear, Nose & Throat - 920 E 1st St	920 East First Street	Duluth	MN	Active
DSH240047AY	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Diagnostic Imaging	1015 E. 1st Street	Duluth	MN	Active
DSH240047AZ	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Emergency Department	1015 E 1st St	Duluth	MN	Active
DSH240047B	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Grand Ave	4702 Grand Ave	Duluth	MN	Active
DSH240047BA	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Cardiac Cath Lab - 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047BB	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Cardiac and Pulmonary Rehab Gym	1015 E. 1st Street	Duluth	MN	Active
DSH240047BC	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Cardiac Diagnostic Testing	1015 E. 1st Street	Duluth	MN	Active
DSH240047BD	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hospital - Diagnostic Imaging	1015 E 1st Street	Duluth	MN	Active
DSH240047BE	Child	DSH	St. Luke's Hospital of Duluth	ST. LUKE'S HOSPITAL INFUSION CLINIC BUILDING A 2ND FLOOR - INFUSION CLINIC BUILDING A 2ND FLOOR	1012 E. 2ND STREET	DULUTH	MN	Active
DSH240047BF	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Duluth Surgery Center - Surgical Services	920 E 1st St	Duluth	MN	Active
DSH240047C	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Surgical & Procedural Care 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047D	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Superior Clinic	109 N 28th St. East	SUPERIOR	WI	Active
DSH240047E	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Superior Surgery Center	109 N 28th St. East	Superior	WI	Active
DSH240047F	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Cardiology - 1001 E Superior St	1001 East Superior St.	Duluth	MN	Active
DSH240047G	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Woodland Ave	1400 Woodland Ave	Duluth	MN	Active
DSH240047H	Child	DSH	St. Luke's Hospital of Duluth	St. Luke's Urgent Care--Mariner Medical	109 N 28th St. East	Superior	WI	Active
DSH240047J	Child	DSH	St. Luke's Hospital of Duluth	St. Luke's Urgent Care--Denfeld Medical	4702 Grand Ave	Duluth	MN	Active
DSH240047K	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Hermantown Clinic	4190 Loberg Avenue	Hermantown	MN	Active
DSH240047L	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Pulmonary Medicine - 920 E 1st St	920 E 1st St.	Duluth	MN	Active
DSH240047M	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Dermatology - 920 E 1st St	920 E 1st St.	Duluth	MN	Active
DSH240047N	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Cardiothoracic Surgery - 920 E 1st St	920 E 1st St.	Duluth	MN	Active
DSH240047P	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Allergy & Immunology - 920 E 1st St	920 E 1st St.	Duluth	MN	Active
DSH240047Q	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Eye Care - Duluth	324 W Superior St.	Duluth	MN	Active
DSH240047R	Child	DSH	St. Luke's Hospital of Duluth	St. Luke's Medical Arts Clinic	324 W Superior St.	Duluth	MN	Terminated
DSH240047S	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - 26 E Superior St	26 E Superior St.	Duluth	MN	Active
DSH240047T	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Behavioral Health Clinic - Duluth	220 N 6TH Ave. E	DULUTH	MN	Active
DSH240047U	Child	DSH	St. Luke's Hospital of Duluth	St. Luke's Plastic Surgery Associates	1012 E 2nd St	Duluth	MN	Terminated
DSH240047V	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Physical Medicine & Rehab 1015 E 1st St	1012 E 2nd St	Duluth	MN	Active
DSH240047W	Child	DSH	St. Luke's Hospital of Duluth	Apirus St. Luke's Clinic - Duluth - Pediatrics - 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047X	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Orthopedics & Sports Medicine - 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047Y	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Gastroenterology 1015 E 1st St	1015 E 1st St	Duluth	MN	Active
DSH240047Z	Child	DSH	St. Luke's Hospital of Duluth	Aspirus St. Luke's Clinic - Duluth - Neurosurgery - 1015 E 1st St	1015 E 1st St	Duluth	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Becker, Katherine Vice President Corporate Compliance St. Luke's Hospital of Duluth 2182495357	Kolz, Stacy 340B Pharmacy Program Supervisor Aspirus, Inc. 7156104236	4/2/2025 8:35 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1801835970 (MN)		3/14/2025 1:10 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1801835970 (MN)		3/14/2025 1:10 PM
Dates	Last Date That 340B Drugs Purchased	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		12/17/2024 10:50 AM
Details	State	Update	OPA Cancel Termination Request	To Be Terminated	Active	12/17/2024 10:50 AM
Terminations	Termination Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		12/17/2024 10:50 AM
Terminations	Termination Effective Date	Update	OPA Cancel Termination Request	1/1/2025 12:00:00 AM		12/17/2024 10:50 AM
Terminations	Termination Reason	Update	OPA Cancel Termination Request	Change of covered entity type		12/17/2024 10:50 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/22/2024 11:02 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	10/22/2024 11:02 AM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/22/2024 11:02 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	10/22/2024 11:02 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	10/22/2024 11:02 AM
Details	Last Recertification Date	Update	Recertification	9/7/2023 6:27:47 PM	8/29/2024 4:27:01 PM	8/29/2024 4:27 PM
Contacts	Authorizing Official	Update	Change Request	Johnson, Chris H. Controller St. Luke's Hospital of Duluth 2182495486	Boeselager, Michael Vice President Support Services St. Luke's Hospital of Duluth 2182492459	6/26/2024 6:55 AM
Details	Last Recertification Date	Update	Recertification		9/7/2023 6:27:47 PM	9/7/2023 6:27 PM
Details	State	Update		Approved	Active	7/1/2023 12:01 AM
Addresses	Main Address	Insert	New Registration		1012 E. 2ND STREET DULUTH, MN 55802	5/24/2023 7:52 AM
Addresses	Billing Address	Insert	New Registration		ST. LUKE'S HOSPITAL OF DULUTH 915 EAST FIRST STREET DULUTH, MN 55805	5/24/2023 7:52 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	5/24/2023 7:52 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1801835970	5/24/2023 7:52 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	5/24/2023 7:52 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1801835970	5/24/2023 7:52 AM
Medicaid Billing	NPI: State	Insert	New Registration		MN	5/24/2023 7:52 AM
Contacts	Signed By	Insert	New Registration		Johnson, Chris H. Controller St. Luke's Hospital of Duluth 2182495486	5/24/2023 7:52 AM
Details	340B ID	Update	New Registration		DSH240047BE	5/24/2023 7:52 AM
Details	Entity Subname	Update	New Registration	ST. LUKE'S HOSPITAL ITCA2	ST. LUKE'S HOSPITAL INFUSION CLINIC BUILDING A 2ND FLOOR - INFUSION CLINIC BUILDING A 2ND FLOOR	5/24/2023 7:52 AM
Dates	Participating Approval Date	Update	New Registration		5/24/2023 7:52:35 AM	5/24/2023 7:52 AM
Details	State	Update	New Registration	Pending	Approved	5/24/2023 7:52 AM
Dates	Signed By Date	Update	New Registration		5/23/2023 4:26:27 PM	5/24/2023 7:52 AM
Dates	Start Date	Update	New Registration		7/1/2023 12:00:00 AM	5/24/2023 7:52 AM
Addresses	Main Address	Insert	New Registration		1012 E. 2ND STREET DULUTH, MN 55802	4/14/2023 2:50 PM
Addresses	Billing Address	Insert	New Registration		ST. LUKE'S HOSPITAL OF DULUTH 915 EAST FIRST STREET DULUTH, MN 55805	4/14/2023 2:50 PM
Contacts	Authorizing Official	Insert	New Registration		Johnson, Chris H. Controller St. Luke's Hospital of Duluth 2182495486	4/14/2023 2:50 PM
Contacts	Primary Contact	Insert	New Registration		Becker, Katherine Vice President Corporate Compliance St. Luke's Hospital of Duluth 2182495357	4/14/2023 2:50 PM
Details	Assistance Received From Date	Insert	New Registration			4/14/2023 2:50 PM
Details	Assistance Received To Date	Insert	New Registration			4/14/2023 2:50 PM
Details	Last Recertification Date	Insert	New Registration			4/14/2023 2:50 PM
Details	Grant Number	Insert	New Registration			4/14/2023 2:50 PM
Details	340B ID	Insert	New Registration			4/14/2023 2:50 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/14/2023 2:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/14/2023 2:50 PM
Details	Medicare Provider Number	Insert	New Registration		240047	4/14/2023 2:50 PM
Details	Entity Name	Insert	New Registration		St. Luke's Hospital of Duluth	4/14/2023 2:50 PM
Details	NOFO Number	Insert	New Registration			4/14/2023 2:50 PM
Details	Program Code	Insert	New Registration		DSH	4/14/2023 2:50 PM
Details	Entity Subname	Insert	New Registration		ST. LUKE'S HOSPITAL ITCA2	4/14/2023 2:50 PM
Dates	Participating Approval Date	Insert	New Registration			4/14/2023 2:50 PM
Details	State	Insert	New Registration		Pending	4/14/2023 2:50 PM
Dates	Registration Date	Insert	New Registration		4/14/2023 2:50:21 PM	4/14/2023 2:50 PM
Dates	Signed By Date	Insert	New Registration			4/14/2023 2:50 PM
Dates	Start Date	Insert	New Registration			4/14/2023 2:50 PM
Terminations	Termination Comments	Insert	New Registration			4/14/2023 2:50 PM
Terminations	Termination Date	Insert	New Registration			4/14/2023 2:50 PM
Terminations	Termination Effective Date	Insert	New Registration			4/14/2023 2:50 PM
Terminations	Termination Reason	Insert	New Registration			4/14/2023 2:50 PM