340B Drug Pricing Program Database
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CAH521329-74 ST MARYS HOSPITAL OF SUPERIOR (Terminated)
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Main Details
Name
ST MARYS HOSPITAL OF SUPERIOR
Subdivision Name
Essentia Health Hayward Clinic - Diabetes Center - Essentia Health Hayward Clinic - Diabetes Center
Type
Critical Access Hospital
Rural
No
340B ID
CAH521329-74
Medicare Provider Number
521329
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/5/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/22/2023
Last Recertification Date
8/15/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Essentia Health
Bradley Beard, Chief Operating Officer
(218) 786-2652
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
11134 N STATE RD 77
Hayward, WI 54843
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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