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RRC240210-00 HEALTHEAST ST JOHNS HOSPITAL (Approved)
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Main Details
Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC240210-00
Medicare Provider Number
240210
Additional Details
Current Program Status
Approved
Registration Date
4/11/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/16/2025
Last Recertification Date
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
HealthEast Care System
Dean Huska, Director - Pharmacy Contracting
(651) 324-9440
Addresses
Street Address
1575 BEAM AVE
MAPLEWOOD, MN 55109-1126
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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