340B Drug Pricing Program Database
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DSH240036P ST. CLOUD HOSPITAL (Terminated)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
Dialysis - Home Hemodialysis
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036P
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
8/16/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
CentraCare
Michael Allan Blair, Chief Financial Officer
(320) 255-5665
Primary Contact
St Cloud Hospital
Mary Phipps, Senior Director Pharmacy
(320) 251-2700 Ext: 71287
Addresses
Street Address
2035 15th Street North
Suite 210
Saint Cloud, MN 56303
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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