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DSH240080BD UNIVERSITY OF MINNESOTA MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Psychiatric Emergency Room
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080BD
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
University of Minnesota Medical Center
Charles Cooper, 340B Program Manager
(612) 672-5179
Addresses
Street Address
2312 S. 6th Street
Minneapolis, MN 55454
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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