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CAH241325-02 CCM Health (Terminated)
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Main Details
Name
CCM Health
Subdivision Name
Clara City Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241325-02
Medicare Provider Number
241325
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/25/2016
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
7/1/2020
Other
Contacts
Authorizing Official
CCM Health
Brian Lovdahl, CEO
(320) 321-8101
Primary Contact
CCM Health
Samantha Padula, Director of Pharmacy
(320) 321-8175
Addresses
Street Address
140 NW 1st Ave.
Suite 2
Clara City, MN 56222
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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