340B Drug Pricing Program Database
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DSH240047AW St. Luke's Hospital of Duluth (Active)
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Main Details
Name
St. Luke's Hospital of Duluth
Subdivision Name
Aspirus St. Luke's Clinic - Duluth - Clinical Nutrition - 1000 E 1st St
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240047AW
Medicare Provider Number
240047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/6/2018
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
St. Luke's Hospital of Duluth
Michael Boeselager, Vice President Support Services
(218) 249-2459
Primary Contact
Aspirus, Inc.
Stacy Kolz, 340B Pharmacy Program Supervisor
(715) 610-4236
Addresses
Street Address
1011 E 1st St.
2nd Floor
Duluth, MN 55805-2242
Billing Address
St. Luke's Hospital of Duluth
915 East First Street
Duluth, MN 55805
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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