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DSH240080BJ UNIVERSITY OF MINNESOTA MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Nephrology Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080BJ
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/5/2015
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
Fairview Health Services
Bryan John Lundberg, VP 340B Program
(218) 340-4695
Addresses
Street Address
909 Fulton Street SE
Clinics and Surgery Center, 3rd Floor North
Minneapolis, MN 55455
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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