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SCH240043-41 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 Lea - Mayo Clinic Health System-Albert Lea Anticoagulation Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-41
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2020
Participating Start Date
5/7/2020
Participating Approval Date
5/7/2020
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
MayoClinic
Kristin S. Johnson, Vice Chair Administration SE MN
(507) 434-9806
Primary Contact
Mayo Clinic
Darrin Christopherson, Senior Business Analyst-340B Midwest Programs
(507) 284-5035
Addresses
Street Address
210 St. Mary Avenue
Albert Lea, MN 56007
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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