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ESSENTIA HEALTH VIRGINIA PHARMACY
DSH240084 ESSENTIA HEALTH VIRGINIA
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Covered Entity Details
Entity Name
ESSENTIA HEALTH VIRGINIA
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240084
Entity Address
901 9TH STREET NORTH
VIRGINIA, MN 55792-2398
Medicare Provider Number
240084
Participating Start Date
1/1/2021
Last Recertification Date
9/3/2024
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
5/15/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dan Milbridge, COO/Administrator
(218) 749-9496
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
5/15/2015
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