Covered Entity Details

DSH240106E REGIONS HOSPITAL (Terminated) - information as of 6/6/2025 4:24:46 AM

Main Details

Name

REGIONS HOSPITAL

Subdivision Name

HSC CT Scan

Type

Disproportionate Share Hospital

Rural

340B ID

DSH240106E

Medicare Provider Number

240106

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

6/4/2012

Participating Start Date

7/1/2012

Participating Approval Date

6/28/2012

Last Recertification Date

8/17/2016

Termination Date
Termination Reason

10/1/2016
Site closure

Contacts

Authorizing Official

Regions Hospital
HEIDI CONRAD, CFO
(651) 254-0900

Primary Contact

Regions Hospital
Craig L. Harvey, Director of Pharmacy Svcs
(651) 254-9560

Addresses

Street Address

401 Phalen Blvd
Saint Paul, MN 55130

Billing Address
Same as Street Address

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	422247400
		1629006457

Shipping Addresses

Same as Street Address

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
DSH240106A	Child	DSH	REGIONS HOSPITAL	REGIONS OUTPATIENT SERVICES	401 PHALEN BLVD	ST. PAUL	MN	Terminated
DSH240106B	Child	DSH	REGIONS HOSPITAL	REGIONS OUTPATIENT SERVICES	435 PHALEN BLVD	ST. PAUL	MN	Terminated
DSH240106C	Child	DSH	REGIONS HOSPITAL	HSC Dexascan	401 Phalen Blvd	St. Paul	MN	Terminated
DSH240106D	Child	DSH	REGIONS HOSPITAL	HSC Ultrasound	401 Phalen Blvd	Saint Paul	MN	Terminated
DSH240106E	Child	DSH	REGIONS HOSPITAL	HSC CT Scan	401 Phalen Blvd	Saint Paul	MN	Terminated
DSH240106F	Child	DSH	REGIONS HOSPITAL	HSC 401 Magnetic Resonance Imaging	401 Phalen Blvd	Saint Paul	MN	Active
DSH240106G	Child	DSH	REGIONS HOSPITAL	HSC PET Scan	401 Phalen Blvd	Saint Paul	MN	Terminated
DSH240106J	Child	DSH	REGIONS HOSPITAL	HSC Same Day Surgery	435 Phalen Blvd	St. Paul	MN	Active
DSH240106K	Child	DSH	REGIONS HOSPITAL	HSC GI Clinic/Services	435 Phalen Blvd	Saint Paul	MN	Active
DSH240106L	Child	DSH	REGIONS HOSPITAL	SLEEP HEALTH CENTER	2688 MAPLEWOOD DR	MAPLEWOOD	MN	Active
DSH240106M	Child	DSH	REGIONS HOSPITAL	ADAP (ALCOHOL DRUG ABUSE PROGRAM)	445 ETNA STREET	ST PAUL	MN	Terminated
DSH240106N	Child	DSH	REGIONS HOSPITAL	CARDIOPULMONARY REHAB	2575 UNIVERSITY AVE STE 140 WESTGATE	ST PAUL	MN	Terminated
DSH240106P	Child	DSH	REGIONS HOSPITAL	HSC HAND THERAPY	401 PHALEN BLVD	ST PAUL	MN	Terminated
DSH240106Q	Child	DSH	REGIONS HOSPITAL	DIGESTIVE CARE ENDOSCOPY PROCEDURES	435 PHALEN BLVD	ST PAUL	MN	Active
DSH240106R	Child	DSH	REGIONS HOSPITAL	Digestive Clinic	435 Phalen Blvd	Saint Paul	MN	Terminated
DSH240106S	Child	DSH	REGIONS HOSPITAL	PHYSICAL THERAPY	1710 Suburban Square	SAINT PAUL	MN	Terminated
DSH240106T	Child	DSH	REGIONS HOSPITAL	REGIONS HOSPITAL REHABILITATION INS	8425 SEASONS PKWY STE 103	WOODBURY	MN	Terminated
DSH240106U	Child	DSH	REGIONS HOSPITAL	RIVERSIDE HAND AND PHYSICAL THERAPY	2220 RIVERSIDE AVENUE	MINNEAPOLIS	MN	Terminated
DSH240106V	Child	DSH	REGIONS HOSPITAL	REGIONS HOSPITAL - NEUROSCIENCE CENTER RADIOLOGY	295 PHALEN BLVD	ST. PAUL	MN	Active
DSH240106W	Child	DSH	REGIONS HOSPITAL	REGIONS HOSPITAL - Med Mgmt	435 PHALEN BLVD	SAINT PAUL	MN	Active
DSH240106X	Child	DSH	REGIONS HOSPITAL	REGIONS HOSPITAL - Infusion Clinic - Coon Rapids	11850 BLACKFOOT ST NW	COON RAPIDS	MN	Active
DSH240106Y	Child	DSH	REGIONS HOSPITAL	REGIONS HOSPITAL - Cancer Clinic - Coon Rapids	11850 BLACKFOOT ST NW	COON RAPIDS	MN	Active

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	CONRAD, HEIDI CFO 6512540900	CONRAD, HEIDI CFO Regions Hospital 6512540900	10/19/2017 12:21 PM
Contacts	Signed By	Update	CONRAD, HEIDI CFO 6512540900	CONRAD, HEIDI CFO Regions Hospital 6512540900	10/19/2017 12:21 PM
Contacts	Primary Contact	Update	Harvey, Craig L. Director of Pharmacy Svcs 6512549560	Harvey, Craig L. Director of Pharmacy Svcs Regions Hospital 6512549560	10/2/2017 1:45 PM
Contacts	Authorizing Official	Insert		CONRAD, HEIDI CFO 6512540900	1/10/2017 11:02 AM
Contacts	Signed By	Insert		CONRAD, HEIDI CFO 6512540900	1/10/2017 11:02 AM
Contacts	Primary Contact	Insert		Harvey, Craig L. Director of Pharmacy Svcs 6512549560	8/17/2016 7:11 AM
Addresses	Main Address	Insert		401 Phalen Blvd Saint Paul, MN 55130	8/17/2016 7:10 AM
Details	Last Recertification Date	Update	8/5/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/17/2016 7:10 AM
Dates	Last Date That 340B Drugs Purchased	Update		12/31/2015 12:00:00 AM	8/17/2016 7:10 AM
Details	State	Update	Active	Terminated	8/17/2016 7:10 AM
Terminations	Termination Comments	Update		Drugs not purchased for this site. Removing from eligible list.	8/17/2016 7:10 AM
Terminations	Termination Date	Update		10/1/2016 12:00:00 AM	8/17/2016 7:10 AM
Terminations	Termination Effective Date	Update		12/31/2015 12:00:00 AM	8/17/2016 7:10 AM
Terminations	Termination Reason	Update		Site closure	8/17/2016 7:10 AM
Details	Last Recertification Date	Update	8/7/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/7/2015 12:00 PM
Details	Last Recertification Date	Update	9/6/2013 10:45:53 AM	8/7/2014 12:00:00 AM	8/7/2014 8:47 AM
Details	Last Recertification Date	Update		9/6/2013 10:45:53 AM	9/6/2013 10:45 AM
Details	340B ID	Update	IS-DR-DSH240106E	DSH240106E	6/28/2012 9:05 AM
Dates	Participating Approval Date	Update		6/28/2012 12:00:00 AM	6/28/2012 9:05 AM
Details	State	Update	Pending	Active	6/28/2012 9:05 AM
Dates	Start Date	Update		7/1/2012 12:00:00 AM	6/28/2012 9:05 AM
Details	340B ID	Update	DR?-DSH240106E	IS-DR-DSH240106E	6/26/2012 1:14 PM
Details	340B ID	Update	IS-DR-DSH240106E	DR?-DSH240106E	6/21/2012 12:45 PM
Details	340B ID	Update	OUTPATIENT_ONLINE_REG	IS-DR-DSH240106E	6/4/2012 4:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	6/4/2012 2:46 PM
Medicaid Billing	Medicaid: Number	Insert		422247400	6/4/2012 2:46 PM
Medicaid Billing	Medicaid: State	Insert		MN	6/4/2012 2:46 PM
Medicaid Billing	NPI: Number	Insert		1629006457	6/4/2012 2:46 PM
Details	Last Recertification Date	Insert			6/4/2012 2:46 PM
Details	Grant Number	Insert			6/4/2012 2:46 PM
Details	340B ID	Insert		OUTPATIENT_ONLINE_REG	6/4/2012 2:46 PM
Details	Is Authorizing Official EHB Data	Insert			6/4/2012 2:46 PM
Dates	Last Date That 340B Drugs Purchased	Insert			6/4/2012 2:46 PM
Details	Medicare Provider Number	Insert		240106	6/4/2012 2:46 PM
Details	Entity Name	Insert		REGIONS HOSPITAL	6/4/2012 2:46 PM
Details	Program Code	Insert		DSH	6/4/2012 2:46 PM
Details	Entity Subname	Insert		HSC CT Scan	6/4/2012 2:46 PM
Dates	Participating Approval Date	Insert			6/4/2012 2:46 PM
Details	State	Insert		Pending	6/4/2012 2:46 PM
Dates	Registration Date	Insert		6/4/2012 12:00:00 AM	6/4/2012 2:46 PM
Dates	Signed By Date	Insert		6/4/2012 12:00:00 AM	6/4/2012 2:46 PM
Dates	Start Date	Insert			6/4/2012 2:46 PM
Terminations	Termination Comments	Insert			6/4/2012 2:46 PM
Terminations	Termination Date	Insert			6/4/2012 2:46 PM
Terminations	Termination Effective Date	Insert			6/4/2012 2:46 PM
Terminations	Termination Reason	Insert			6/4/2012 2:46 PM