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DSH240080AV UNIVERSITY OF MINNESOTA MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Palliative Care Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080AV
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
8/24/2015
Termination Date
Termination Reason
4/1/2016
Site closure
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
516 Delaware St. SE
PWB Clinic 1C
Minneapolis, MN 55455
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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