| Details | Last Recertification Date | Update | Recertification | 2/9/2024 3:04:42 PM | 2/14/2025 2:11:00 PM | 2/14/2025 2:11 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2023 7:06:38 PM | 2/9/2024 3:04:42 PM | 2/9/2024 3:04 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2022 9:03:29 AM | 2/9/2023 7:06:38 PM | 2/9/2023 7:06 PM |
| Contacts | Authorizing Official | Update | Change Request | Diouf, Colleen McDonald
CEO
University of Minnesota/Community-University Health Care Center
6123010698 | Dwivedi, Roli
CEO
University of Minnesota/Community-University Health Care Center
6123013433 | 1/26/2023 7:11 PM |
| Contacts | Primary Contact | Update | PC Change Request | Zachary, Thomas Donald
CFO
Community-University Health Care Center
7636393055 | Ogren, Heather
Director of Compliance
University of Minnesota/Community-University Health Care Center
6123010885 | 1/26/2023 3:46 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2021 3:44:48 PM | 2/9/2022 9:03:29 AM | 2/9/2022 9:03 AM |
| Contacts | Primary Contact | Update | Change Request | Ogren, Heather
Interim Compliance Manager
University of Minnesota/Community-University Health Care Center
6123010881 | Zachary, Thomas Donald
CFO
Community-University Health Care Center
7636393055 | 1/3/2022 11:30 AM |
| Contacts | Primary Contact | Update | Change Request | CIPOLLE, CHRISTINA
PHARMACIST
Community-University Health Care Center at the University of Minnesota
6123010965 | Ogren, Heather
Interim Compliance Manager
University of Minnesota/Community-University Health Care Center
6123010881 | 11/3/2021 3:54 PM |
| Contacts | Primary Contact | Update | Change Request | Thao, May
Chief Compliance Officer
University of Minnesota/Community-University Health Care Center
6123010885-7636707950 | CIPOLLE, CHRISTINA
PHARMACIST
Community-University Health Care Center at the University of Minnesota
6123010965 | 4/15/2021 10:44 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1114019858 | 2/9/2021 3:44 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MN | 2/9/2021 3:44 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1114019858 ( ) | | 2/9/2021 3:44 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2020 6:12:50 PM | 2/9/2021 3:44:48 PM | 2/9/2021 3:44 PM |
| Contacts | Primary Contact | Update | Change Request | CIPOLLE, CHRISTINA
PHARMACIST
Community-University Health Care Center at the University of Minnesota
6123010965 | Thao, May
Chief Compliance Officer
University of Minnesota/Community-University Health Care Center
6123010885-7636707950 | 12/28/2020 9:09 AM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2019 4:51:31 PM | 1/30/2020 6:12:50 PM | 1/30/2020 6:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/9/2018 11:36:18 AM | 1/31/2019 4:51:31 PM | 1/31/2019 4:51 PM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2017 12:00:00 AM | 2/9/2018 11:36:18 AM | 2/9/2018 11:36 AM |
| Contacts | Authorizing Official | Update | | Diouf, Colleen McDonald
CEO
6123010698 | Diouf, Colleen McDonald
CEO
University of Minnesota/Community-University Health Care Center
6123010698 | 11/1/2017 4:35 PM |
| Contacts | Primary Contact | Update | | CIPOLLE, CHRISTINA
PHARMACIST
6123010965 | CIPOLLE, CHRISTINA
PHARMACIST
Community-University Health Care Center at the University of Minnesota
6123010965 | 10/16/2017 10:08 PM |
| Addresses | Main Address | Insert | | |
2001 Bloomington Ave
Minneapolis, MN 55404-3074 | 2/2/2017 9:18 AM |
| Contacts | Authorizing Official | Update | | MILLS, DEANNA
CEO
6123010882 | Diouf, Colleen McDonald
CEO
6123010698 | 2/2/2017 9:18 AM |
| Contacts | Primary Contact | Insert | | | CIPOLLE, CHRISTINA
PHARMACIST
6123010965 | 2/2/2017 9:18 AM |
| Details | Last Recertification Date | Update | | 3/1/2016 12:00:00 AM | 2/2/2017 12:00:00 AM | 2/2/2017 9:17 AM |
| Addresses | Shipping Address | Insert | | | COMMUNITY UNIVERSITY HEALTH CARE CENTER
2001 BLOOMINGTON AVENUE
SUITE 152 - PHARMACY
MINNEAPOLIS, MN 55404 | 9/26/2016 2:23 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 9/26/2016 2:23 PM |
| Medicaid Billing | Medicaid: Number | Insert | | | 1114019858 | 9/26/2016 2:23 PM |
| Medicaid Billing | Medicaid: State | Insert | | | MN | 9/26/2016 2:23 PM |
| Medicaid Billing | NPI: Number | Insert | | | 1114019858 | 9/26/2016 2:23 PM |
| Details | Last Recertification Date | Update | | 2/12/2015 12:00:00 AM | 3/1/2016 12:00:00 AM | 3/1/2016 2:26 PM |
| Contacts | Authorizing Official | Insert | | | MILLS, DEANNA
CEO
6123010882 | 2/12/2015 1:31 PM |
| Details | Last Recertification Date | Update | | 3/19/2014 12:00:00 AM | 2/12/2015 12:00:00 AM | 2/12/2015 1:31 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/19/2014 12:00:00 AM | 3/19/2014 2:13 PM |
| Details | Entity Name | Update | | COMMUNITY UNIVERSITY HEALTH CARE CENTER | REGENTS OF THE UNIVERSITY OF MINNESOTA | 3/19/2014 2:13 PM |
| Details | Entity Subname | Update | | VARIETY CHILDREN'S CLINIC | COMMUNITY-UNIVERSITY HEALTH CARE CENTER | 3/19/2014 2:13 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/25/2013 9:17 AM |
| Details | Last Recertification Date | Insert | | | | 9/20/2010 6:42 PM |
| Details | Grant Number | Insert | | | H80CS00241 | 9/20/2010 6:42 PM |
| Details | 340B ID | Insert | | | CH0513810 | 9/20/2010 6:42 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/20/2010 6:42 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/20/2010 6:42 PM |
| Details | Medicare Provider Number | Insert | | | | 9/20/2010 6:42 PM |
| Details | Entity Name | Insert | | | COMMUNITY UNIVERSITY HEALTH CARE CENTER | 9/20/2010 6:42 PM |
| Details | Program Code | Insert | | | CH | 9/20/2010 6:42 PM |
| Details | Entity Subname | Insert | | | VARIETY CHILDREN'S CLINIC | 9/20/2010 6:42 PM |
| Dates | Participating Approval Date | Insert | | | 5/20/2004 12:00:00 AM | 9/20/2010 6:42 PM |
| Details | State | Insert | | | Active | 9/20/2010 6:42 PM |
| Dates | Registration Date | Insert | | | 10/1/2001 12:00:00 AM | 9/20/2010 6:42 PM |
| Dates | Signed By Date | Insert | | | | 9/20/2010 6:42 PM |
| Dates | Start Date | Insert | | | 10/1/2001 12:00:00 AM | 9/20/2010 6:42 PM |
| Terminations | Termination Comments | Insert | | | | 9/20/2010 6:42 PM |
| Terminations | Termination Date | Insert | | | | 9/20/2010 6:42 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/20/2010 6:42 PM |
| Terminations | Termination Reason | Insert | | | | 9/20/2010 6:42 PM |
| Details | Comments Public | Insert | | | 6/18/09 SHIP TO ADDED ADMIN CORRECTION - WAS 340B ID#FQHCLA024 | 9/20/2010 6:42 PM |