340B Drug Pricing Program Database
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DSH240057AU ABBOTT NORTHWESTERN HOSPITAL (Active)
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Main Details
Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Courage Kenny Sports & Physical Therapy-Edina
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240057AU
Medicare Provider Number
240057
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/22/2021
Last Recertification Date
8/12/2024
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
8100 W 78th St
205
Edina, MN 55439-2560
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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