340B Drug Pricing Program Database
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RRC350070-23 INNOVIS HEALTH (Terminated)
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Main Details
Name
INNOVIS HEALTH
Subdivision Name
INNOVIS HEALTH, LLC - ESSENTIA HEALTH SOUTH UNIVERSITY CLINIC / General Surgery
Type
Rural Referral Center
Rural
Yes
340B ID
RRC350070-23
Medicare Provider Number
350070
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/17/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/25/2022
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
4/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Essentia Health
Al Hurley, COO
(701) 364-7667
Primary Contact
Essentia Health
Ryan Olivier, Pharmacy 340B Manager
(218) 576-0677
Addresses
Street Address
1702 UNIVERSITY DR S
FARGO, ND 58103-4940
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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