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CAH241329-01 LAKEWOOD HEALTH SYSTEM (Active)
Main Details
Name
LAKEWOOD HEALTH SYSTEM
Subdivision Name
LAKEWOOD CLINIC-EAGLE BEND
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241329-01
Medicare Provider Number
241329
Outpatient Facility Provider Number
243421
Contacts
Authorizing Official
Lakewood Health System
Joseph Thomas Reycraft, CFO
(218) 894-8194
Primary Contact
Lakewood Health System
Mark Carlson, Director of 340B Pharmacy
(218) 296-2351
Additional Details
Current Program Status
Active
Registration Date
9/23/2010
Participating Start Date
9/24/2010
Participating Approval Date
9/24/2010
Last Recertification Date
8/28/2023
Addresses
Street Address
815 HWY 71 SOUTH
EAGLE BEND, MN 56446
Billing Address
LAKEWOOD HEALTH SYSTEM
49725 COUNTY 83
STAPLES, MN 56479
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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