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DSH240080J UNIVERSITY OF MINNESOTA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
ADVANCED TREATMENT CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080J
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
6/3/2010
Participating Start Date
7/1/2010
Participating Approval Date
6/18/2010
Last Recertification Date
8/26/2024
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
909 FULTON ST. SE
CLINICS AND SURGERY CENTER, 2ND FLOOR SOUTH
MINNEAPOLIS, MN 55455
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/8/2010- UPDATED ADDRESS (WAS 420 DELAWARE ST. SE, SUITE 230) AND ADDED SHIPPING ADD.
09/23/2010
1/11/12 change AO from Hill to Donnelly, ADD NPI JH
06/03/2010
April 2025
April 2025
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