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DSH240210D HEALTHEAST ST JOHNS HOSPITAL (Terminated)
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Main Details
Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
HealthEast Vascular Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240210D
Medicare Provider Number
240210
Outpatient Facility Provider Number
240210
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
9/15/2022
Termination Date
Termination Reason
10/1/2023
Hospital Outpatient facility no longer eligible
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
1875 Woodwinds Drive
Suite 150
Woodbury, MN 55125
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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