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ESSENTIA HEALTH HIBBING PHARMACY
DSH240019 SMDC MEDICAL CENTER
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Covered Entity Details
Entity Name
SMDC MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240019
Entity Address
502 E 2ND ST
DULUTH, MN 55805
Medicare Provider Number
240019
Participating Start Date
9/3/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
ESSENTIA HEALTH HIBBING PHARMACY
Pharmacy Address
730 E 34TH ST STE A
HIBBING, MN 55746-2349
Pharmacy Comments
Contract Details
Approval Date
1/12/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James M. Garvey, SVP Hospital Operations East Region
(218) 786-4878
Contract Pharmacy Representative
Essentia Health
Tim Cernohous, Director of Ambulatory Pharmacy
(218) 786-8516
Signed By Date
1/12/2018
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