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GRAND ST. PAUL CVS, L.L.C.
DSH240047 St. Luke's Hospital of Duluth
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Covered Entity Details
Entity Name
St. Luke's Hospital of Duluth
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240047
Entity Address
915 East First Street
Duluth, MN 55805
Medicare Provider Number
240047
Participating Start Date
10/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
GRAND ST. PAUL CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16290
1001 13TH ST S
VIRGINIA, MN 55792
Pharmacy Comments
Contract Details
Approval Date
4/22/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/6/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Eric Lohn, Vice President/CFO
(218) 249-5475
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/22/2021
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