340B Drug Pricing Program Database
ALLINA HEALTH COTTAGE GROVE PHARMACY
DSH240115A MERCY HOSPITAL - information as of 6/18/2025 12:19:41 AM
Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians
Type
Disproportionate Share Hospital
340B ID
DSH240115A
Entity Address
3960 Coon Rapids Blvd NW
220
Coon Rapids, MN 55433-2589
Medicare Provider Number
240115
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
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
3/28/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
4/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
3/28/2024
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