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DSH240057E ABBOTT NORTHWESTERN HOSPITAL (Terminated)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians Edina / SW Perinatal Ultrasound
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057E
Medicare Provider Number
240057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/23/2015
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
7/1/2022
Other
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
6525 France Ave Sout
205
Edina, MN 55435-2176
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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