340B Drug Pricing Program Database
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DSH240001G North Memorial Health Care (Terminated)
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Main Details
Name
North Memorial Health Care
Subdivision Name
Sleep Lab MG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001G
Medicare Provider Number
240001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2013
Participating Start Date
10/1/2013
Participating Approval Date
7/15/2013
Last Recertification Date
8/16/2016
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
North Memorial Health
Kevin J. Croston, CEO
(763) 581-4702
Primary Contact
North Memorial Health
Paul R Krogh, Director, Pharmacy
(763) 581-2129
Addresses
Street Address
13800 83rd Way N
Suite 102
Maple Grove, MN 55369
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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