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DSH240057C ABBOTT NORTHWESTERN HOSPITAL (Terminated)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians Maple Grove / MG High Risk Perinatal Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057C
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
9/8/2020
Termination Date
Termination Reason
10/1/2021
Site closure
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
9600 Upland Lane N
Suite 180
Maple Grove, MN 55369-4495
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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