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DSH240036AT ST. CLOUD HOSPITAL (Terminated)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
PASSAGES - SCH Recovery Plus
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036AT
Medicare Provider Number
240036
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/17/2018
Last Recertification Date
Termination Date
Termination Reason
10/1/2019
Site closure
Contacts
Authorizing Official
St. Cloud Hospital
Kurt Tyler Otto, Vice President Operations, Specialty Division
(320) 251-2700 Ext: 55971
Primary Contact
St Cloud Hospital
Mary Phipps, Senior Director Pharmacy
(320) 251-2700 Ext: 71287
Addresses
Street Address
121 PARK AVENUE S
ST CLOUD, MN 56301-3780
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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