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DSH240004BD HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER (Active)
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Main Details
Name
HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
Subdivision Name
CSC PMR and TBI Clinic - PMR and TBI Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240004BD
Medicare Provider Number
240004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/8/2019
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Hennepin Healthcare System
Wendy Stulac-Motzel, Chief Operating Officer
(612) 873-6123
Primary Contact
Hennepin Healthcare Systems, Inc. - HCMC
Heather Anderson, Pharmacy Revenue Manager
(612) 873-3225
Addresses
Street Address
715 South 8th Street, Level 3
Minneapolis, MN 55404
Billing Address
Hennepin Healthcare System, Inc. - Hennepin County Medical Center
701 Park Ave. South
Minneapolis, MN 55415
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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