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CAH241350-00 ESSENTIA HEALTH MOOSE LAKE (Active)
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Main Details
Name
ESSENTIA HEALTH MOOSE LAKE
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241350-00
Medicare Provider Number
241350
Additional Details
Current Program Status
Active
Registration Date
8/3/2010
Participating Start Date
8/19/2010
Participating Approval Date
8/3/2010
Last Recertification Date
8/23/2024
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
4572 COUNTY ROAD 61
MOOSE LAKE, MN 55767
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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