340B Drug Pricing Program Database
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DSH240057F ABBOTT NORTHWESTERN HOSPITAL (Active)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Courage Kenny Rehab Associates Pain Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057F
Medicare Provider Number
240057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/23/2015
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Allina Health
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Primary Contact
Allina Health
Jeremy Enger, 340B Program Manager
(612) 760-7836
Addresses
Street Address
3915 Golden Valley Road
Golden Valley, MN 55422-4249
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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