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DSH240080BX UNIVERSITY OF MINNESOTA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
UMMC Maple Grove Cancer Infusion - Infusion Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080BX
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2024
Participating Start Date
10/1/2024
Participating Approval Date
8/6/2024
Last Recertification Date
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
Fairview Health Services
Bryan John Lundberg, VP 340B Program
(218) 340-4695
Addresses
Street Address
14500 99th Avenue North
Maple Grove, MN 55369
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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