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CAH521329-53 ST MARYS HOSPITAL OF SUPERIOR (Active)
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Main Details
Name
ST MARYS HOSPITAL OF SUPERIOR
Subdivision Name
Essentia Health Hayward Clinic - Non Invasive
Type
Critical Access Hospital
Rural
No
340B ID
CAH521329-53
Medicare Provider Number
521329
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/9/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/24/2019
Last Recertification Date
8/18/2024
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
11134 N STATE RD 77
HAYWARD, WI 54843
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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