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DSH240047AY 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 Hospital - Diagnostic Imaging
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240047AY
Medicare Provider Number
240047
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/3/2020
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
1015 E. 1st Street
2nd Floor
Duluth, MN 55805
Billing Address
St. Luke's Hospital of Duluth
915 E 1st Street
Duluth, MN 55802
Comments
Medicaid Billing
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