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DSH240004H HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER (Terminated)
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Main Details
Name
HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
Subdivision Name
HCMC Sr Care at Augustana
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240004H
Medicare Provider Number
240004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/13/2013
Last Recertification Date
9/5/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Hennepin County Medical Center - Hennepin Healthcare Inc
Emily Blomberg, Chief Operating Official
(612) 873-9913
Primary Contact
Hennepin Healthcare Systems, Inc. - HCMC
Christene Marie Jolowsky, Pharmacy Director
(612) 873-9917
Addresses
Street Address
1425 10th Avenue South
Minneapolis, MN 55404
Billing Address
Hennepin Healthcare System, Inc. - Hennepin County Medical Center
701 Park Ave. South
Minneapolis, MN 55415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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