340B Drug Pricing Program Database
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DSH240047U St. Luke's Hospital of Duluth (Terminated)
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Main Details
Name
St. Luke's Hospital of Duluth
Subdivision Name
St. Luke's Plastic Surgery Associates
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240047U
Medicare Provider Number
240047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/21/2015
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
St. Luke's Hospital of Duluth
Michael Boeselager, Vice President Support Services
(218) 249-2459
Primary Contact
St. Luke's Hospital of Duluth
Katherine Becker, Vice President Corporate Compliance
(218) 249-5357
Addresses
Street Address
1012 E 2nd St
Level 4
Duluth, MN 55805-2200
Billing Address
St. Luke's Hospital of Duluth
915 East First Street
Duluth, MN 55805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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