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DSH240001M North Memorial Health Care (Terminated)
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Main Details
Name
North Memorial Health Care
Subdivision Name
N MEM CARDIOVASCULAR SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240001M
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
9825 HOSPITAL DRIVE
SUITE 200
MAPLE GROVE, MN 55369-4479
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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June 2025
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