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DSH240063 HEALTHEAST ST JOSEPHS HOSPITAL (Terminated)
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Main Details
Name
HEALTHEAST ST JOSEPHS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240063
Medicare Provider Number
240063
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
HealthEast Care System
Dean Huska, Director - Pharmacy Contracting
(651) 324-9440
Addresses
Street Address
45 WEST 10TH STREET
ST PAUL, MN 55102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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