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DSH240084AU ESSENTIA HEALTH VIRGINIA (Terminated)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
ESENTIA HEALTH VIRGINIA CLINIC / Vascular Diagnostics - VIR
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084AU
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/3/2016
Last Recertification Date
8/29/2019
Termination Date
Termination Reason
1/1/2020
Other
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
1101 9TH ST N
VIRGINIA, MN 55792-2329
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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