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ASPIRUS ST. LUKE'S PHARMACY-DULUTH
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
ASPIRUS ST. LUKE'S PHARMACY-DULUTH
Pharmacy Address
1000 E 1ST ST STE 200
DULUTH, MN 55805
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Strange, President/CEO
(218) 249-5486
Contract Pharmacy Representative
St. Luke's Hospital of Duluth
Kristopher Haugen, Pharmacist in Charge
(218) 249-2460
Signed By Date
4/10/2017
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