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SCH240043-05 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (ToBeTerminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
Mayo Clinic Health System-Albert Lea-Wells Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-05
Medicare Provider Number
240043
Outpatient Facility Provider Number
240043
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
8/28/2014
Last Recertification Date
8/14/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
Mayo Clinic
Travis C. Paul, Regional Chair of Administration SWMN
(608) 392-9716
Primary Contact
Mayo Clinic Health System
Charles Buell, 340B Analyst
(507) 266-1189
Addresses
Street Address
301 S BROADWAY AVE
WELLS, MN 56097-1735
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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