Covered Entity Details

RRC240210-03 HEALTHEAST ST JOHNS HOSPITAL (ToBeTerminated) - information as of 6/16/2025 12:58:30 AM

Main Details

Name

HEALTHEAST ST JOHNS HOSPITAL

Subdivision Name

Fairview Cancer Infusion Woodbury - Infusion Therapy

Type

Rural Referral Center

Rural

340B ID

RRC240210-03

Medicare Provider Number

240210

Outpatient Facility Provider Number

Additional Details

Current Program Status

ToBeTerminated

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/22/2025

Last Recertification Date

Termination Date
Termination Reason

7/1/2025
Other

Contacts

Authorizing Official

Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382

Primary Contact

HealthEast Care System
Dean Huska, Director - Pharmacy Contracting
(651) 324-9440

Addresses

Street Address

1875 Woodwinds Drive
Woodbury, MN 55125

Billing Address

HealthEast St. John's Hospital
1575 Beam Avenue
Maplewood, MN 55109

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MN	410852300,514179601	1447218482

Shipping Addresses

Shipping Address 1

HealthEast Woodwinds Hospital
1925 Woodwinds Drive
Inpatient Pharmacy
Woodbury, MN 55125

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC240210-01	Child	RRC	HEALTHEAST ST JOHNS HOSPITAL	Medication Management Clinic - Medication Therapy Management	1600 St. John's Blvd	Maplewood	MN	ToBeTerminated
RRC240210-02	Child	RRC	HEALTHEAST ST JOHNS HOSPITAL	Pain Center - Pain Center	1600 St. John's Blvd	Maplewood	MN	ToBeTerminated
RRC240210-03	Child	RRC	HEALTHEAST ST JOHNS HOSPITAL	Fairview Cancer Infusion Woodbury - Infusion Therapy	1875 Woodwinds Drive	Woodbury	MN	ToBeTerminated
RRC240210-04	Child	RRC	HEALTHEAST ST JOHNS HOSPITAL	HealthEast Vascular Center Maplewood - Vascular Center	2945 Hazelwood Street	Maplewood	MN	ToBeTerminated
RRC240210-05	Child	RRC	HEALTHEAST ST JOHNS HOSPITAL	Fairview Cancer Center Woodbury - Oncology	1875 Woodwinds Drive	Woodbury	MN	ToBeTerminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/5/2025 12:00:00 AM	6/5/2025 2:35 PM
Details	State	Update	Termination Request	Approved	To Be Terminated	6/5/2025 2:35 PM
Terminations	Termination Date	Update	Termination Request		7/1/2025 12:00:00 AM	6/5/2025 2:35 PM
Terminations	Termination Effective Date	Update	Termination Request		6/5/2025 12:00:00 AM	6/5/2025 2:35 PM
Terminations	Termination Reason	Update	Termination Request		Other	6/5/2025 2:35 PM
Contacts	Signed By	Insert	New Registration		Trysla, Trudi Noel Chief Legal Officer Fairview Health Services 6126726382	4/22/2025 2:03 PM
Details	340B ID	Update	New Registration		RRC240210-03	4/22/2025 2:03 PM
Details	Entity Subname	Update	New Registration	Fairview Cancer Infusion Woodbury	Fairview Cancer Infusion Woodbury - Infusion Therapy	4/22/2025 2:03 PM
Dates	Participating Approval Date	Update	New Registration		4/22/2025 2:03:20 PM	4/22/2025 2:03 PM
Details	State	Update	New Registration	Pending	Approved	4/22/2025 2:03 PM
Dates	Signed By Date	Update	New Registration		4/17/2025 1:49:44 PM	4/22/2025 2:03 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/22/2025 2:03 PM
Addresses	Main Address	Insert	New Registration		1875 Woodwinds Drive Woodbury, MN 55125	4/11/2025 12:01 PM
Addresses	Billing Address	Insert	New Registration		HealthEast St. John's Hospital 1575 Beam Avenue Maplewood, MN 55109	4/11/2025 12:01 PM
Addresses	Shipping Address	Insert	New Registration		HealthEast Woodwinds Hospital 1925 Woodwinds Drive Inpatient Pharmacy Woodbury, MN 55125	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		410852300	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		514179601	4/11/2025 12:01 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MN	4/11/2025 12:01 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1447218482	4/11/2025 12:01 PM
Medicaid Billing	NPI: State	Insert	New Registration		MN	4/11/2025 12:01 PM
Contacts	Authorizing Official	Insert	New Registration		Trysla, Trudi Noel Chief Legal Officer Fairview Health Services 6126726382	4/11/2025 12:01 PM
Contacts	Primary Contact	Insert	New Registration		Huska, Dean Director - Pharmacy Contracting HealthEast Care System 6513249440	4/11/2025 12:01 PM
Details	Assistance Received From Date	Insert	New Registration			4/11/2025 12:01 PM
Details	Assistance Received To Date	Insert	New Registration			4/11/2025 12:01 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2025 12:01 PM
Details	Grant Number	Insert	New Registration			4/11/2025 12:01 PM
Details	340B ID	Insert	New Registration			4/11/2025 12:01 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2025 12:01 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2025 12:01 PM
Details	Medicare Provider Number	Insert	New Registration		240210	4/11/2025 12:01 PM
Details	Entity Name	Insert	New Registration		HEALTHEAST ST JOHNS HOSPITAL	4/11/2025 12:01 PM
Details	NOFO Number	Insert	New Registration			4/11/2025 12:01 PM
Details	Program Code	Insert	New Registration		RRC	4/11/2025 12:01 PM
Details	Entity Subname	Insert	New Registration		Fairview Cancer Infusion Woodbury	4/11/2025 12:01 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2025 12:01 PM
Details	State	Insert	New Registration		Pending	4/11/2025 12:01 PM
Dates	Registration Date	Insert	New Registration		4/11/2025 12:01:21 PM	4/11/2025 12:01 PM
Dates	Signed By Date	Insert	New Registration			4/11/2025 12:01 PM
Dates	Start Date	Insert	New Registration			4/11/2025 12:01 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2025 12:01 PM
Terminations	Termination Date	Insert	New Registration			4/11/2025 12:01 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2025 12:01 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2025 12:01 PM