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DSH240075 ST. JOSEPHS MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPHS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240075
Medicare Provider Number
240075
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/4/2015
Last Recertification Date
9/1/2016
Termination Date
Termination Reason
1/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Essentia Health
David Pilot, CFO
(218) 828-7642
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
523 NORTH THIRD STREET
BRAINERD, MN 56401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/4/15 Hospital previously participated as SCH240075-00 from 4/1/15 until converted to DSH effective 1/1/16
11/04/2015
Hospital previously participated as SCH240075-00; converted to DSH effective 1/1/16
10/23/2015
April 2025
April 2025
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