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SCH240043-29 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (ToBeTerminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
MAYO CLINIC HEALTH SYSTEM - AUSTIN - Austin Anticoagulation
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-29
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
ToBeTerminated
Registration Date
10/4/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Termination Date
Termination Reason
7/1/2025
Change of covered entity type
Contacts
Authorizing Official
Mayo Clinic
Travis C. Paul, Regional Chair of Administration SWMN
(608) 392-9716
Primary Contact
Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853
Addresses
Street Address
1000 1st Drive NW
AUSTIN, MN 55912-2941
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2018; Terminated 1/1/2021; Reinstated 1/1/2025.
10/09/2024
May 2025
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