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SCH240043-43 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-Austin - Endoscopy
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-43
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2020
Participating Start Date
1/1/2021
Participating Approval Date
10/27/2020
Last Recertification Date
9/15/2021
Termination Date
Termination Reason
10/1/2022
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
MayoClinic
Kristin S. Johnson, Vice Chair Administration SE MN
(507) 434-9806
Primary Contact
Mayo Clinic
Alicia Buda, Operations Manager
(507) 293-3251
Addresses
Street Address
1000 1st Drive NW
Austin, MN 55912
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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