340B Drug Pricing Program Database
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DSH240115G MERCY HOSPITAL (Active)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Adult Mental Health Outpatient Program
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240115G
Medicare Provider Number
240115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/4/2019
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
520 Osborne Rd
330 & 350
Fridley, MN 55432
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2016, terminated 7/1/2018. Reinstated 10/1/2019.
07/31/2019
April 2025
April 2025
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