340B Drug Pricing Program Database
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DSH240080BQ UNIVERSITY OF MINNESOTA MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Sleep Center - Sleep Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240080BQ
Medicare Provider Number
240080
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/4/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/19/2018
Last Recertification Date
9/3/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Fairview Health Services
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Primary Contact
Fairview Health Services
Bryan John Lundberg, VP 340B Program
(218) 340-4695
Addresses
Street Address
606 24th Avenue South
First Floor
Suite 106
Minneapolis, MN 55454
Billing Address
Fairview Health Services
PO Box 59318
Minneapolis, MN 55459
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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