340B Drug Pricing Program Database
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DSH240001A North Memorial Health Care (Active)
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Main Details
Name
North Memorial Health Care
Subdivision Name
Breast Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001A
Medicare Provider Number
240001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/8/2013
Participating Start Date
10/1/2013
Participating Approval Date
7/15/2013
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Maple Grove Hospital
Trevor Sawallish, CEO
(763) 581-4721
Primary Contact
North Memorial Health
Barbara Hintzen, Pharmacy Program Manager
(763) 581-2099
Addresses
Street Address
3366 Oakdale Ave N. Suite LL
Robbinsdale, MN 55025
Billing Address
North Memorial Health
3300 Oakdale Ave North
Robbinsdale, MN 55422
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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