340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH240036D ST. CLOUD HOSPITAL (Terminated)
Print
Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
Outpatient Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036D
Medicare Provider Number
240036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/21/2016
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
St. Cloud Hospital
Kurt Tyler Otto, Vice President Operations, Specialty Division
(320) 251-2700 Ext: 55971
Primary Contact
St Cloud Hospital
Mary Phipps, Senior Director Pharmacy
(320) 251-2700 Ext: 71287
Addresses
Street Address
1406 Sixth Avenue North
Saint Cloud, MN 56303
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
April 2025
April 2025
week
S
M
T
W
T
F
S
14
30
31
1
2
3
4
5
15
6
7
8
9
10
11
12
16
13
14
15
16
17
18
19
17
20
21
22
23
24
25
26
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session