340B Drug Pricing Program Database
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DSH240071C Allina Health Faribault Medical Center (Active)
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Main Details
Name
Allina Health Faribault Medical Center
Subdivision Name
Allina Health Cancer Institute - Faribault
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240071C
Medicare Provider Number
240071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2021
Participating Start Date
1/1/2022
Participating Approval Date
11/23/2021
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
200 State Ave
Faribault, MN 55021-6339
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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