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SCH240075-29 ST JOSEPHS MEDICAL CENTER (Terminated)
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Main Details
Name
ST JOSEPHS MEDICAL CENTER
Subdivision Name
Essentia Health St. Joseph's - Brainerd Clinic / Nephrology
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240075-29
Medicare Provider Number
240075
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/19/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/22/2018
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
Essentia Health
Michael J Larson, Vice President of Operations
(218) 828-7656
Primary Contact
Essentia Health
Bryan Lundberg, 340b Program Manager
(218) 828-7143
Addresses
Street Address
2024 S 6TH ST
BRAINERD, MN 56401
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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