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DSH240106F REGIONS HOSPITAL (Active)
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Main Details
Name
REGIONS HOSPITAL
Subdivision Name
HSC 401 Magnetic Resonance Imaging
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240106F
Medicare Provider Number
240106
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/29/2019
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Regions Hospital
John M Clark, VP Finance
(651) 254-0900
Primary Contact
Regions Hospital
Tanya Y Barnhart, Director, Pharmaceutical Services
(651) 254-9560
Addresses
Street Address
401 Phalen Blvd
Saint Paul, MN 55130
Billing Address
Regions Hospital
640 Jackson St
St Paul, MN 55101
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (07/01/2012) until terminated effective date: ((10/01/2016), reinstatement effective date: (10/01/2019)
07/29/2019
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