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CAH241360-08 ESSENTIA HEALTH DEER RIVER (Terminated)
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Main Details
Name
ESSENTIA HEALTH DEER RIVER
Subdivision Name
Deer River Healthcare Center- Deer River Clinic / Fam/Genl Practice
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241360-08
Medicare Provider Number
241360
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/19/2014
Last Recertification Date
9/8/2015
Termination Date
Termination Reason
10/1/2015
Other
Contacts
Authorizing Official
Essentia Health
Steven Feltman, Senior Finance Advisor
(218) 259-8763
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
115 10th Avenue NE, Suite A
Deer River, MN 56636
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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