340B Drug Pricing Program Database
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CAH521329-42 ST MARYS HOSPITAL OF SUPERIOR (Terminated)
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Main Details
Name
ST MARYS HOSPITAL OF SUPERIOR
Subdivision Name
Essentia Health Spooner Clinic - Endocrinology
Type
Critical Access Hospital
Rural
No
340B ID
CAH521329-42
Medicare Provider Number
521329
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/23/2019
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Essentia Health
Kim Pearson, Administrator
(715) 817-7017
Primary Contact
Essentia Health
Ryan Olivier, Pharmacy 340B Manager
(218) 576-0677
Addresses
Street Address
1180 CHANDLER DR
SPOONER, WI 54801
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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