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ESSENTIA HEALTH TWO HARBORS PHARMACY
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 TWO HARBORS PHARMACY
Pharmacy Address
802 11TH ST STE C
TWO HARBORS, MN 55616-1670
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barbara R. Wessberg, Administrator/VP
(218) 786-2646
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
7/11/2014
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