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DSH240080AX UNIVERSITY OF MINNESOTA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
UMMC Southdale Cancer Clinic and Infusion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080AX
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/31/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
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
6363 France Ave So
Suite 610
Edina, MN 55435
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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