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DSH240084R ESSENTIA HEALTH VIRGINIA (Active)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Essentia Health Virginia Clinic / Ophthalmology - VIR
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084R
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/17/2020
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
1101 9TH ST N
VIRGINIA, MN 55792
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2015; Terminated 1/1/2020; Reinstated 1/1/2021.
10/19/2020
April 2025
April 2025
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