340B Drug Pricing Program Database
ALLINA HEALTH COTTAGE GROVE PHARMACY
DSH240038D United Hospital - information as of 6/4/2025 12:10:49 PM
Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Nasseff Heart Center - Spine/PC/MH
Type
Disproportionate Share Hospital
340B ID
DSH240038D
Entity Address
255 North Smith
3rd Floor
St Paul, MN 55102
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH COTTAGE GROVE PHARMACY
Pharmacy Address
8611 W POINT DOUGLAS RD S
COTTAGE GROVE, MN 55016-4005
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Phillip J. Krolik, VP, Finance
(651) 241-8827
Contract Pharmacy Representative
Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
4/14/2021
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