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CAH241364-00 COMMUNITY MEMORIAL HOSPITAL (Active)
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Main Details
Name
COMMUNITY MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241364-00
Medicare Provider Number
241364
Additional Details
Current Program Status
Active
Registration Date
4/11/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/16/2019
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Community Memorial Hospital
Brad K Anderson, CFO
(218) 878-7027
Primary Contact
Community Memorial Hospital
Marcia Hoeffling, Director of Pharmacy
(218) 878-7691
Addresses
Street Address
512 SKYLINE BOULEVARD
CLOQUET, MN 55720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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