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CAH241357-01 FIRST CARE MEDICAL SERVICES (Terminated)
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Main Details
Name
FIRST CARE MEDICAL SERVICES
Subdivision Name
OKLEE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241357-01
Medicare Provider Number
241357
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2011
Participating Start Date
4/1/2011
Participating Approval Date
1/14/2011
Last Recertification Date
11/17/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Essentia Health
Kimberly Bodensteiner, CFO
(218) 435-7633
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
3rd & Governor St.
OKLEE, MN 56742
Billing Address
FIRST CARE MEDICAL SERVICES
900 HILLIGOSS BLVD SE
FOSSTON, MN 56542
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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