340B Drug Pricing Program Database
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DSH240047R 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 Medical Arts Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240047R
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
324 W Superior St.
220
Duluth, MN 55802-1707
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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