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CAH241368-00 CentraCare Health - Sauk Centre (Active)
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Main Details
Name
CentraCare Health - Sauk Centre
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH241368-00
Medicare Provider Number
241368
Additional Details
Current Program Status
Active
Registration Date
11/21/2011
Participating Start Date
1/1/2014
Participating Approval Date
12/13/2011
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
CentraCare Health - Sauk Centre
Adam Paulson, Centracare - Sauk Centre President
(320) 352-2221 Ext: 21703
Primary Contact
CentraCare Health- Sauk Centre
Dennis Heinen, Director of Pharmacy
(320) 351-1713
Addresses
Street Address
425 Elm Street North
Sauk Centre, MN 56378
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/26/13 enrolled 1/1/12 thru 9/30/13, not enrolled 10/1/13 thru 12/31/13 due to failure to recertify, reinstated based on on-line registration submitted in Oct. 2013; 1/18/13 information provided of accepted name change by IRS JH 1/17/12 - Updated addr (was 425 North main Street)
11/26/2013
1/18/13 information provided of accepted name change by IRS JH 1/17/12 - Updated addr (was 425 North main Street)
01/18/2013
1/17/12 - Updated addr (was 425 North main Street)
01/17/2012
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