340B Drug Pricing Program Database
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CAH241357-09 First Care Medical Services (Terminated)
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Main Details
Name
First Care Medical Services
Subdivision Name
FOSSTON CLINIC / Cardiology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241357-09
Medicare Provider Number
241357
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/13/2014
Last Recertification Date
9/8/2015
Termination Date
Termination Reason
10/1/2015
Other
Contacts
Authorizing Official
Essentia Health
Kimberly Bodensteiner, CFO
(218) 435-7633
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
900 HILLIGOSS BLVD SE
FOSSTON, MN 56542-1542
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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