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SCH240043-02 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (Terminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
Blooming Prairie Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-02
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
9/10/2020
Termination Date
Termination Reason
1/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
MayoClinic
Kristin S. Johnson, Vice Chair Administration SE MN
(507) 434-9806
Primary Contact
Mayo Clinic
Darrin Christopherson, Senior Business Analyst-340B Midwest Programs
(507) 284-5035
Addresses
Street Address
405 EAST MAIN ST
BLOOMING PRAIRIE, MN 55917-1440
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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