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DSH240196 PHILLIPS EYE INSTITUTE (Terminated)
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Main Details
Name
PHILLIPS EYE INSTITUTE
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240196
Medicare Provider Number
240196
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/20/2017
Last Recertification Date
11/9/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Allina Health
Daniel Conrad, President, Phillips Eye Institute
(612) 775-8815
Primary Contact
Allina
Julie Exner, Financial Analyst, Phillips Eye Institute
(612) 775-8791
Addresses
Street Address
2215 PARK AVENUE
MINNEAPOLIS, MN 55404
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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