340B Drug Pricing Program Database
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DSH520087DG Gundersen Lutheran Medical Center, Inc. (Active)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Winona Campus - Winona Campus -Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087DG
Medicare Provider Number
520087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/5/2021
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Gundersen Health system
Michelle Micka, VP Finance
(608) 775-3131 Ext: 53131
Primary Contact
Gundersen Health System
Loren Carrell, Director
(608) 775-6369
Addresses
Street Address
1122 West Hwy. 61
Winona, MN 55987
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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