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ESSENTIA HEALTH DULUTH 3RD STREET PHARMA
DSH240019 SMDC MEDICAL CENTER
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Covered Entity Details
Entity Name
SMDC MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240019
Entity Address
502 E 2ND ST
DULUTH, MN 55805
Medicare Provider Number
240019
Participating Start Date
9/3/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH DULUTH 3RD STREET PHARMA
Pharmacy Address
400 E 3RD ST STE A
DULUTH, MN 55805-1951
Pharmacy Comments
06/15/2012 change pharmacy name (was DULUTH CLINIC PHARMACY)
Contract Details
Approval Date
2/20/2009
Contract Begin Date
2/20/2009
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
2/12/2009
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