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ESSENTIA HEALTH WEST DULUTH PHARMACY
CH0510280 LAKE SUPERIOR COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
LAKE SUPERIOR COMMUNITY HEALTH CENTER
Subdivision Name
LAKE SUPERIOR HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0510280
Entity Address
4325 Grand Ave
Duluth, MN 55807-2730
Grant Number
H80CS00811
Participating Start Date
10/1/2000
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH WEST DULUTH PHARMACY
Pharmacy Address
4212 GRAND AVE
SUITE A
DULUTH, MN 55807-2737
Pharmacy Comments
Contract Details
Approval Date
10/1/2006
Contract Begin Date
10/1/2006
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
8/28/2006
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