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SCH240043-28 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (Terminated)
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Main Details
Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LEA
Subdivision Name
MAYO CLINIC HEALTH SYSTEM-ALBERT LE - Wells Eye Center
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-28
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/5/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/1/2018
Last Recertification Date
8/16/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
MayoClinic
Kristin S. Johnson, Vice Chair Administration SE MN
(507) 434-9806
Primary Contact
Mayo Clinic
Jenni Hovell, 340B Operations Manager
(507) 284-5061
Addresses
Street Address
301 S BROADWAY
WELLS, MN 56097-1735
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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