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SCH240075-27 ST. JOSEPHS MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPHS MEDICAL CENTER
Subdivision Name
Essentia Health St. Joseph's - Baxter Clinic / OB & Gynecology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240075-27
Medicare Provider Number
240075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
2/10/2015
Last Recertification Date
9/1/2015
Termination Date
Termination Reason
1/1/2016
Change of covered entity type
Contacts
Authorizing Official
Essentia Health
Michael J Larson, Vice President of Operations
(218) 828-7656
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
13060 Isle Drive
Baxter, MN 56425
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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