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RWII55404 Rainbow Health Minnesota (Terminated)
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Main Details
Name
Rainbow Health Minnesota
Subdivision Name
Type
Ryan White Part B
340B ID
RWII55404
Grant Number
X07HA00028
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/2/2022
Last Recertification Date
1/30/2024
Time Period the Assistance was Received
1/1/2024 - 12/31/2024
Termination Date
Termination Reason
4/1/2025
Failure to recertify
Contacts
Authorizing Official
Rainbow Health Minnesota
Jeremy Hanson Willis, CEO
(612) 373-2400
Primary Contact
Rainbow Health Minnesota
AJ Lezama, Telehealth Program Manager
(612) 200-7636
Addresses
Street Address
701 S 4th Ave
Ste. 1500
Minneapolis, MN 55415
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (04/1/2021) until terminated effective date: (4/1/2022), reinstatement effective date: (10/1/2022)
07/26/2022
Participating from effective date: (10/1/2014) until terminated effective date: (04/01/2017), reinstatement effective date: (04/01/2021)
02/11/2021
April 2025
April 2025
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