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DSH240002C ST MARYS MEDICAL CENTER (Terminated)
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Main Details
Name
ST MARYS MEDICAL CENTER
Subdivision Name
Essentia Health Duluth Clinic / - Pulmonary Function Lab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240002C
Medicare Provider Number
240002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/22/2024
Last Recertification Date
Termination Date
Termination Reason
10/1/2024
Change of covered entity type
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
400 E 3RD STREET
DULUTH, MN 55805
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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