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DSH240036AC ST. CLOUD HOSPITAL (Active)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
Addiction Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036AC
Medicare Provider Number
240036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/21/2016
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
CentraCare
Michael Allan Blair, Chief Financial Officer
(320) 255-5665
Primary Contact
St. Cloud Hospital
James Mahowald, Senior Director, Pharmacy Services
(320) 251-2700 Ext: 54084
Addresses
Street Address
3701 12th Street North
Suite 201
Saint Cloud, MN 56303-2048
Billing Address
Saint Cloud Hospital
1406 Sixth Avenue North
Saint Cloud, MN 56303
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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