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DSH240001J North Memorial Health Care (Terminated)
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Main Details
Name
North Memorial Health Care
Subdivision Name
Partial Hospital Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001J
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
8/24/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
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
Outpatient Psychiatric Clinic
3366 Oakdale Ave N. Suite 506
Robbinsdale, MN 55422
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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