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ESSENTIA HEALTH DULUTH 2ND STREET PHARMA
CAH241360-00 DEER RIVER HEALTHCARE CENTER INC
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Covered Entity Details
Entity Name
DEER RIVER HEALTHCARE CENTER INC
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241360-00
Entity Address
115 10TH AVENUE NE
DEER RIVER, MN 56636
Medicare Provider Number
241360
Participating Start Date
1/1/2011
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH DULUTH 2ND STREET PHARMA
Pharmacy Address
402 E 2ND ST
SUITE 6320
DULUTH, MN 55805
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
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
4/15/2024
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