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CAH241376-00 GLACIAL RIDGE HEALTH SYSTEM (Active)
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Main Details
Name
GLACIAL RIDGE HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241376-00
Medicare Provider Number
241376
Additional Details
Current Program Status
Active
Registration Date
8/4/2010
Participating Start Date
10/1/2011
Participating Approval Date
8/4/2010
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Glacial Ridge Health System
KYLE CHASE, CFO
(320) 634-2206
Primary Contact
Glacial Ridge Health System
Diane E Yorkovich, Compliance Officer
(320) 634-2219
Addresses
Street Address
10 FOURTH AVE SE
GLENWOOD, MN 56334
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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7/10/12 THIS RE-INSTATED RECORD FOR CAH241376-00 WAS INADVERTENTLY OVERWRITTEN WITH THE DATA FROM A NEW REGISTRATION FOR THE SAME HOSPITAL ON 9/20/2011, AND THE NEW REGISTRATION WAS APPROVED WITH A START DATE OF 10/1/2011; THE ORIGINAL RECORD VALUES WERE RESTORED IN JUNE 2012 (I.E., THE REINSTATED RECORD'S VALUES). 08/04/11 participating 8/6/10 to 1/1/11, not participating 1/2/11 to 9/30/11
07/10/2012
08/04/11,participating date 8/6/10 to1/1/11, not participating 1/2/11 to 9/30/11
08/04/2011
June 2025
June 2025
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