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CAH241325-04 CCM Health (Active)
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Main Details
Name
CCM Health
Subdivision Name
MILAN CLINIC - Milan Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241325-04
Medicare Provider Number
241325
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2020
Participating Start Date
10/14/2020
Participating Approval Date
10/14/2020
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
CCM Health
Brian Lovdahl, CEO
(320) 321-8101
Primary Contact
CCM Health
Jamie L Malstrom, Director of Pharmacy
(320) 321-8175
Addresses
Street Address
237 2ND ST
MILAN, MN 56262
Billing Address
CCM Health
824 N 11th St
Montevideo, MN 56265
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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