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DSH240210F HEALTHEAST ST JOHNS HOSPITAL (ToBeTerminated)
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Main Details
Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
Pain Center - Pain Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240210F
Medicare Provider Number
240210
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
7/14/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/20/2023
Last Recertification Date
8/26/2024
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
HealthEast Care System
Dean Huska, Director - Pharmacy Contracting
(651) 324-9440
Addresses
Street Address
1600 St. John's Blvd, Suite 101
Maplewood, MN 55109
Billing Address
HealthEast St. John's Hospital
1575 Beam Avenue
Maplewood, MN 55109
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2018, terminated 10/1/2022. Reinstated 10/1/2023.
07/19/2023
April 2025
April 2025
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