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RRC350070-00 INNOVIS HEALTH (Active)
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Main Details
Name
INNOVIS HEALTH
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC350070-00
Medicare Provider Number
350070
Additional Details
Current Program Status
Active
Registration Date
1/12/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/20/2022
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Essentia Health
Al Hurley, COO
(701) 364-7667
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
3000 32ND AVENUE S
FARGO, ND 58103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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