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DSH240075P ST. JOSEPHS MEDICAL CENTER (Terminated)
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Main Details
Name
ST. JOSEPHS MEDICAL CENTER
Subdivision Name
ESSENTIA HEALTH - ST JOSEPH'S BAXTE / OB & Gynecology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240075P
Medicare Provider Number
240075
Outpatient Facility Provider Number
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
4/1/2017
Site closure
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
13060 ISLE DRIVE
BAXTER, MN 56425-8331
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/4/15 Previously participated as SCH240075-27, converted to DSH effective 1/1/16
11/04/2015
Hospital previously participated as SCH240075-27; converted to DSH effective 1/1/16
10/23/2015
May 2025
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