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ESSENTIA HEALTH DULUTH 2ND STREET PHARMA
CAH241321-00 GRACEVILLE HEALTH CENTER
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Covered Entity Details
Entity Name
GRACEVILLE HEALTH CENTER
Subdivision Name
ESSENTIA HEALTH HOLY TRINITY HOSPITAL
Type
Critical Access Hospital
340B ID
CAH241321-00
Entity Address
115 W 2ND ST
GRACEVILLE, MN 56240
Medicare Provider Number
241321
Participating Start Date
9/16/2010
Last Recertification Date
8/28/2024
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
Julie Rosenberg, Administrator
(320) 748-8203
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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