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ESSENTIA HEALTH VIRGINIA 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 VIRGINIA PHARMACY
Pharmacy Address
1101 9TH ST N STE A
VIRGINIA, MN 55792-2329
Pharmacy Comments
Contract Details
Approval Date
7/23/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James M. Garvey, SVP Hospital Operations East Region
(218) 786-4878
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
7/23/2017
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