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CAH351336-00 ST JOSEPHS HOSPITAL & HEALTH CTR (Active)
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Main Details
Name
ST JOSEPHS HOSPITAL & HEALTH CTR
Subdivision Name
Type
Critical Access Hospital
Rural
No
340B ID
CAH351336-00
Medicare Provider Number
351336
Additional Details
Current Program Status
Active
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/24/2015
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Mercy Medical Center
Joseph Lawrence Ruark, VP, Operational Finance
(701) 774-7408
Primary Contact
CommonSpirit Health - Central Region
Mitchell Schultz, RPh, 340b Regional Manager
(701) 928-0620
Addresses
Street Address
2500 Fairway St
DICKINSON, ND 58601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/31/15 participating 4/1/11 until terminated effective 10/1/15, reinstated effective 1/1/16
12/31/2015
April 2025
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