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DSH240080CA UNIVERSITY OF MINNESOTA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
MHealth Fairview Mental Health and Addiction Clinic - MH Senior Intensive Outpatient - Behavioral Health
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080CA
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
525 23rd Ave S
Minneapolis, MN 55454
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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