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DSH240057X ABBOTT NORTHWESTERN HOSPITAL (Terminated)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
VPCI Clinics - Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057X
Medicare Provider Number
240057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/8/2019
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
7/1/2022
Other
Contacts
Authorizing Official
Allina Health
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Primary Contact
Allina Health
Jeremy Enger, 340B Program Manager
(612) 760-7836
Addresses
Street Address
913 E. 26th Street
402
Minneapolis, MN 55407
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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