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DSH240019AW SMDC MEDICAL CENTER (Active)
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Main Details
Name
SMDC MEDICAL CENTER
Subdivision Name
Essentia Health Lakewalk Clinic / Anticoagulation Mgmt - Lkwk
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240019AW
Medicare Provider Number
240019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/24/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/25/2022
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
1502 London Road STE 102
Duluth, MN 55812
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2016, terminated 4/1/2018. Reinstated 4/1/2022.
02/25/2022
May 2025
May 2025
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