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ESSENTIA HEALTH BAXTER PHARMACY
SCH240075-00 ST JOSEPHS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPHS MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH240075-00
Entity Address
523 N 3RD ST
BRAINERD, MN 56401
Medicare Provider Number
240075
Participating Start Date
4/1/2018
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH BAXTER PHARMACY
Pharmacy Address
13060 ISLE DR
BAXTER, MN 56425
Pharmacy Comments
Contract Details
Approval Date
4/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David Pilot, CFO
(218) 828-7642
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
4/15/2015
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