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DSH240004AN HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER (Terminated)
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Main Details
Name
HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
Subdivision Name
BE WELL CLINIC - HCMC Be Well Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240004AN
Medicare Provider Number
240004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/24/2017
Last Recertification Date
9/3/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Hennepin County Medical Center - Hennepin Healthcare Inc
Emily Blomberg, Chief Operating Official
(612) 873-9913
Primary Contact
Hennepin Healthcare Systems, Inc. - HCMC
Christene Marie Jolowsky, Pharmacy Director
(612) 873-9917
Addresses
Street Address
701 4TH AVE. S, STE. 100
MINNEAPOLIS, MN 55415-1631
Billing Address
Hennepin Healthcare System, Inc. - Hennepin County Medical Center
701 Park Ave. South
Minneapolis, MN 55415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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