340B Drug Pricing Program Database
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DSH240115AB MERCY HOSPITAL (Active)
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Main Details
Name
MERCY HOSPITAL
Subdivision Name
Mercy Hospital, Unity Campus - Apheresis - General Lab
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH240115AB
Medicare Provider Number
240115
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/7/2022
Participating Start Date
10/1/2022
Participating Approval Date
7/26/2022
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
550 Osborne Rd NE
Fridley, MN 55432
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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