340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ESSENTIA HEALTH SUPERIOR BELKNAP PHARMAC
DSH240002 ST MARYS MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ST MARYS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240002
Entity Address
402 E 2ND STREET
DULUTH, MN 55805
Medicare Provider Number
240002
Participating Start Date
7/1/2011
Last Recertification Date
8/30/2023
Entity Termination Date
10/1/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH SUPERIOR BELKNAP PHARMAC
Pharmacy Address
204 BELKNAP ST STE 100
SUPERIOR, WI 54880-2905
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Bradley Beard, Chief Operating Officer
(218) 786-2652
Contract Pharmacy Representative
Essentia Health
Kenzie Hohman, Senior Director of Ambulatory Pharmacy
(715) 817-7171
Signed By Date
4/8/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session