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DSH240084CV ESSENTIA HEALTH VIRGINIA (Terminated)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Essentia Heatlh Virginia Clinic / Occupational Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084CV
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/8/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/16/2020
Last Recertification Date
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Dawn Heide, 340B Senior Program Coordinator
(218) 828-7143
Addresses
Street Address
1101 9TH ST N
VIRGINIA, MN 55792
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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