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CAH241309-00 PINE MEDICAL CENTER (Active)
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Main Details
Name
PINE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241309-00
Medicare Provider Number
241309
Additional Details
Current Program Status
Active
Registration Date
3/4/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/20/2011
Last Recertification Date
8/21/2024
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
705 LUNDORFF DR
SANDSTONE, MN 55072
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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