340B Drug Pricing Program Database
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DSH240019DQ SMDC MEDICAL CENTER (Terminated)
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Main Details
Name
SMDC MEDICAL CENTER
Subdivision Name
Essentia Health Lakeside Clinic / Diabetes Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240019DQ
Medicare Provider Number
240019
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/2/2021
Last Recertification Date
9/9/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Ryan Olivier, Pharmacy 340B Manager
(218) 576-0677
Addresses
Street Address
4621 E SUPERIOR ST
DULUTH, MN 55804
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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