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DSH240019A SMDC MEDICAL CENTER (Active)
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Main Details
Name
SMDC MEDICAL CENTER
Subdivision Name
Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240019A
Medicare Provider Number
240019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/10/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/10/2009
Last Recertification Date
8/18/2024
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
420 E 1ST ST
DULUTH, MN 55805
Billing Address
SMDC MEDICAL CENTER
502 EAST SECOND ST
DULUTH, MN 55805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/12/12 change entitiy name with supporting documentation
03/10/2009
May 2025
May 2025
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