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SCH240036-00 St. Cloud Hospital (Terminated)
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Main Details
Name
St. Cloud Hospital
Subdivision Name
Type
Sole Community Hospital
Rural
No
340B ID
SCH240036-00
Medicare Provider Number
240036
Additional Details
Current Program Status
Terminated
Registration Date
1/20/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/6/2012
Last Recertification Date
8/5/2015
Termination Date
Termination Reason
7/1/2016
Change of covered entity type
Contacts
Authorizing Official
St. Cloud Hospital
Greg Klugherz, CFO
(320) 255-5655
Primary Contact
Jennifer Hagen, Director Ambulatory Pharmacy Services
(320) 229-5199 Ext: 70979
Addresses
Street Address
1406 Sixth Avenue North
Saint Cloud, MN 56303-1901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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