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DSH240084DP ESSENTIA HEALTH VIRGINIA (Active)
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Main Details
Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Essentia Health International Falls Clinic / Clinic Pharm Withdrawal - Essentia Health International Falls Clinic / Clinic Pharm Withdrawal
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240084DP
Medicare Provider Number
240084
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/5/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/23/2023
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Essentia Health
Sam Stone, COO
(218) 742-8600 Ext: 2496
Primary Contact
Essentia Health
Nick Sharrow, Pharmacy Business Services Director
(218) 606-9246
Addresses
Street Address
2501 KEENAN DR
International Falls, MN 56649
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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