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SCH240043-08 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (Terminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
AUSTIN / SAME DAY CLINIC
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-08
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/6/2014
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
10/1/2021
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
1000 1ST DRIVE NW
AUSTIN, MN 55912
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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