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DSH240036AF ST. CLOUD HOSPITAL (Terminated)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
Perinatal Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036AF
Medicare Provider Number
240036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2016
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
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April 2025
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