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DSH240084EC ESSENTIA HEALTH VIRGINIA (Active)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Essentia Health Ely Clinic / - Weight Management - ELY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084EC
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/23/2025
Last Recertification Date
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
300 W CONAN ST
ELY, MN 55731
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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