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ESSENTIA HEALTH SUPERIOR PHARMACY
CAH241340-00 NORTHERN PINES MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTHERN PINES MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH241340-00
Entity Address
5211 HIGHWAY 110
AURORA, MN 55705
Medicare Provider Number
241340
Participating Start Date
10/1/2012
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH SUPERIOR PHARMACY
Pharmacy Address
3500 TOWER AVE STE A
SUPERIOR, WI 54880
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/7/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Laura Ackman, President
(218) 229-2211 Ext: 4222
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
10/18/2016
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