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CAH241362-02 CENTRACARE HEALTH-MONTICELLO (Terminated)
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Main Details
Name
CENTRACARE HEALTH-MONTICELLO
Subdivision Name
CENTRACARE HEALTH - MONTICELLO MEDI
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241362-02
Medicare Provider Number
241362
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/10/2019
Last Recertification Date
8/30/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
CentraCare Health-Monticello
Jason Philip Weaver, Divsion Director of Finance
(763) 271-2842
Primary Contact
CentraCare Health-Monticello
Natalie Adams, Pharmacy Director
(763) 271-2425
Addresses
Street Address
1107 HART BLVD
SECOND FLOOR
MONTICELLO, MN 55362-3071
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating start 10/1/2016, terminated 4/1/2019, reinstatement 1/1/2020
10/10/2019
June 2025
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