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ESSENTIA HEALTH DULUTH 2ND STREET PHARMA
CAH241357-00 FIRST CARE MEDICAL SERVICES
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Covered Entity Details
Entity Name
FIRST CARE MEDICAL SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241357-00
Entity Address
900 HILLIGOSS BLVD SE
FOSSTON, MN 56542
Medicare Provider Number
241357
Participating Start Date
4/1/2011
Last Recertification Date
9/3/2024
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
Kimberly Bodensteiner, CFO
(218) 435-7633
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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