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DSH240019AB SMDC MEDICAL CENTER (Active)
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Main Details
Name
SMDC MEDICAL CENTER
Subdivision Name
Essentia Health Hermantown Clinic / Family Practice
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240019AB
Medicare Provider Number
240019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/29/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/21/2014
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
4855 W ARROWHEAD RD
HERMANTOWN, MN 55811
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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