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DSH240210 HEALTHEAST ST JOHNS HOSPITAL (ToBeTerminated)
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Main Details
Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240210
Medicare Provider Number
240210
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
8/26/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
HealthEast Care System
Dean Huska, Director - Pharmacy Contracting
(651) 324-9440
Addresses
Street Address
1575 BEAM AVENUE
MAPLEWOOD, MN 55109
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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