340B Drug Pricing Program Database
ESSENTIA HEALTH SUPERIOR BELKNAP PHARMAC
CAH521329-00 ST MARYS HOSPITAL OF SUPERIOR - information as of 5/4/2025 10:41:41 PM
Covered Entity Details
Entity Name
ST MARYS HOSPITAL OF SUPERIOR
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH521329-00
Entity Address
3500 TOWER AVE
SUPERIOR, WI 54880
Medicare Provider Number
521329
Participating Start Date
9/30/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH SUPERIOR BELKNAP PHARMAC
Pharmacy Address
204 BELKNAP ST STE 100
SUPERIOR, WI 54880-2905
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kim Pearson, Administrator
(715) 817-7017
Contract Pharmacy Representative
Essentia Health
Kenzie Hohman, Senior Director of Ambulatory Pharmacy
(715) 817-7171
Signed By Date
4/5/2021
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