340B Drug Pricing Program Database
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DSH240057A ABBOTT NORTHWESTERN HOSPITAL (Active)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Abbott Northwestern WestHealth Emergency Dept
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057A
Medicare Provider Number
240057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/18/2018
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
2855 Campus Drive
Plymouth, MN 55441
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date (10/1/2015) until terminated effective date (7/1/2018), reinstatement effective date (01/01/2019)
10/18/2018
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