340B Drug Pricing Program Database
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DSH240036AY ST. CLOUD HOSPITAL (Terminated)
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Main Details
Name
ST. CLOUD HOSPITAL
Subdivision Name
St. Cloud Hospital Dialysis - Aitkin - Dialysis - Dialysis
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240036AY
Medicare Provider Number
240036
Outpatient Facility Provider Number
243543
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/14/2021
Last Recertification Date
8/16/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
CentraCare
Michael Allan Blair, Chief Financial Officer
(320) 255-5665
Primary Contact
St Cloud Hospital
Mary Phipps, Senior Director Pharmacy
(320) 251-2700 Ext: 71287
Addresses
Street Address
200 Bunker Hill Drive
Aitkin, MN 56431
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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