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CAH241356-04 MILLE LACS HOSPITAL (Terminated)
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Main Details
Name
MILLE LACS HOSPITAL
Subdivision Name
MILLE LACS HEALTH SYSTEM - RADIOLOGY
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241356-04
Medicare Provider Number
241356
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/23/2020
Last Recertification Date
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Mille Lacs Health System
Bill Nelson, CEO
(320) 532-2580
Primary Contact
Mille Lacs Health System
Jennifer McDonnell, Pharmacy Manager
(320) 532-2490
Addresses
Street Address
27378 STATE HIGHWAY 18
GARRISON, MN 56450-8642
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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