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DSH240214 MAPLE GROVE HOSPITAL (Active)
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Main Details
Name
MAPLE GROVE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240214
Medicare Provider Number
240214
Additional Details
Current Program Status
Active
Registration Date
10/12/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/16/2017
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Maple Grove Hospital
Trevor Sawallish, CEO
(763) 581-4721
Primary Contact
North Memorial Health
Barbara Hintzen, Pharmacy Program Supervisor
(763) 581-2099
Addresses
Street Address
9875 HOSPITAL DRIVE
MAPLE GROVE, MN 55369
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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