340B Drug Pricing Program Database
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DSH240001K North Memorial Health Care (Active)
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Main Details
Name
North Memorial Health Care
Subdivision Name
HUBERT H HUMPHREY CANCER CTR
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001K
Medicare Provider Number
240001
Outpatient Facility Provider Number
240001
Additional Details
Current Program Status
Active
Registration Date
7/7/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/29/2014
Last Recertification Date
9/3/2024
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
3435 WEST BROADWAY
SUITE 1135
ROBBINSDALE, MN 55422
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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