340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ESSENTIA HEALTH LAKEWALK PHARMACY
DSH240075 ST. JOSEPHS MEDICAL CENTER
Print
Covered Entity Details
Entity Name
ST. JOSEPHS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240075
Entity Address
523 NORTH THIRD STREET
BRAINERD, MN 56401
Medicare Provider Number
240075
Participating Start Date
1/1/2016
Last Recertification Date
9/1/2016
Entity Termination Date
1/1/2018
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH LAKEWALK PHARMACY
Pharmacy Address
1502 LONDON RD STE 101
DULUTH, MN 55812-1787
Pharmacy Comments
Contract Details
Approval Date
1/10/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
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
1/10/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session