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SCH240043-07 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (Terminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
Mayo Clinic Health System-Albert Lea-Lake Mills Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-07
Medicare Provider Number
240043
Outpatient Facility Provider Number
240043
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/28/2014
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
7/1/2024
Site closure
Contacts
Authorizing Official
Mayo Clinic
Eric Douglas Crockett, Regional Chair-Administration
(507) 422-5678 Ext: 5079909402
Primary Contact
Mayo Clinic
Alicia Buda, Operations Manager
(507) 293-3251
Addresses
Street Address
309 S 10TH AVE E
LAKE MILLS, IA 50450-1849
Billing Address
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN
1000 1ST DRIVE NW
AUSTIN, MN 55912
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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