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SCH240064-00 GRAND ITASCA CLINIC AND HOSPITAL (Active)
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Main Details
Name
GRAND ITASCA CLINIC AND HOSPITAL
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH240064-00
Medicare Provider Number
240064
Additional Details
Current Program Status
Active
Registration Date
5/24/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/9/2011
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Range Regional Health Services
Todd Kenton Christensen, VP Finance
(218) 362-6638
Primary Contact
Grand Itasca Clinic and Hospital
Amanda J Jones, Pharmacy Buyer/340B Coordinator
(218) 999-1882
Addresses
Street Address
1601 GOLF COURSE ROAD
GRAND RAPIDS, MN 55744
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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