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DSH240001L North Memorial Health Care (Terminated)
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Main Details
Name
North Memorial Health Care
Subdivision Name
NORTH MEMORIAL CARDIOVASCULAR SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001L
Medicare Provider Number
240001
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/1/2015
Participating Start Date
1/1/2016
Participating Approval Date
12/3/2015
Last Recertification Date
8/24/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
North Memorial Health
Kevin J. Croston, CEO
(763) 581-4702
Primary Contact
North Memorial Health
Paul R Krogh, Director, Pharmacy
(763) 581-2129
Addresses
Street Address
15450 HIGHWAY 7 225
MINNETONKA, MN 55345-3522
Billing Address
North Memorial Health
3300 Oakdale Ave North
Robbinsdale, MN 55422
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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