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CAH241321-03 HOLY TRINITY HOSPITAL (Terminated)
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Main Details
Name
HOLY TRINITY HOSPITAL
Subdivision Name
GRACEVILLE HEALTH CENTER HOME HEALTH
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241321-03
Medicare Provider Number
241321
Outpatient Facility Provider Number
248045
Additional Details
Current Program Status
Terminated
Registration Date
9/16/2010
Participating Start Date
9/16/2010
Participating Approval Date
9/16/2010
Last Recertification Date
9/4/2015
Termination Date
Termination Reason
10/1/2015
Other
Contacts
Authorizing Official
Essentia Health
Julie Rosenberg, Administrator
(320) 748-8203
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 576-0745
Addresses
Street Address
115 W. 2ND STREET
GRACEVILLE, MN 56240
Billing Address
HOLY TRINITY HOSPITAL
PO BOX 157
GRACEVILLE,, MN 56240
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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