340B Drug Pricing Program Database
ALLINA HEALTH WOODBURY PHARMACY
DSH240115L MERCY HOSPITAL - information as of 4/23/2025 11:56:11 PM
Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Mercy Hospital, Unity Campus 3 East Imaging - Cardiac Services
Type
Disproportionate Share Hospital
340B ID
DSH240115L
Entity Address
550 Osborne Rd NE
Fridley, MN 55432-2718
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 WOODBURY PHARMACY
Pharmacy Address
8675 VALLEY CREEK RD
WOODBURY, MN 55125-2337
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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