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DSH240084AZ ESSENTIA HEALTH VIRGINIA (Active)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Essentia Health Virginia Clinic / Pulmonary Function Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084AZ
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/22/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/23/2024
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
1101 9th Street North
Virginia, MN 55792
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (04/01/2017) until terminated effective date: (01/01/2020); reinstatement effective date: (July 1, 2024)
04/23/2024
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