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CAH241321-05 GRACEVILLE HEALTH CENTER (Terminated)
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Main Details
Name
GRACEVILLE HEALTH CENTER
Subdivision Name
Essentia Health Graceville Clinic / Podiatry
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241321-05
Medicare Provider Number
241321
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
1/30/2017
Last Recertification Date
9/4/2018
Termination Date
Termination Reason
10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Essentia Health
Julie Rosenberg, Administrator
(320) 748-8203
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
117 W 2nd Street
Graceville, MN 56240-4845
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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