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DSH240080AK UNIVERSITY OF MINNESOTA MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Derm Rheumatology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080AK
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/31/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/25/2012
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
University of Minnesota Medical Center
Charles Cooper, 340B Program Manager
(612) 672-5179
Addresses
Street Address
909 Fulton Street SE
Clinics and Surgery Center, 3rd Floor East
Minneapolis, MN 55455
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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