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ACCREDO HEALTH GROUP INC
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
ACCREDO HEALTH GROUP INC
Pharmacy Address
2915 WATERS RD STE 109
EAGAN, MN 55121-1562
Pharmacy Comments
Contract Details
Approval Date
4/3/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Boeselager, Vice President Support Services
(218) 249-2459
Contract Pharmacy Representative
Accredo Health Group, Inc.
Travis Behrens, Lead Director, 340B Client Sales
(407) 988-7044
Signed By Date
4/3/2025
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