340B Drug Pricing Program Database
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DSH240036AU ST. CLOUD HOSPITAL (Terminated)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
JOURNEY HOME - A&C Outpatient
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036AU
Medicare Provider Number
240036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/17/2018
Last Recertification Date
8/30/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
CentraCare
Michael Allan Blair, Chief Financial Officer
(320) 255-5665
Primary Contact
CentraCare
Tegan J Buckley, Senior Director Pharmacy Services
(320) 251-2700 Ext: 76336
Addresses
Street Address
1485 10TH AVENUE NE
SAUK RAPIDS, MN 56379-9838
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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