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SCH240043-50 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 ALBERT LE - COVID Infusion
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH240043-50
Medicare Provider Number
240043
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2023
Participating Start Date
1/1/2024
Participating Approval Date
12/1/2023
Last Recertification Date
Termination Date
Termination Reason
10/1/2024
Site closure
Contacts
Authorizing Official
Mayo Clinic
Eric Douglas Crockett, Regional Chair-Administration
(507) 422-5678 Ext: 5079909402
Primary Contact
Mayo Clinic
Alicia Buda, Operations Manager
(507) 293-3251
Addresses
Street Address
1000 1ST DR NW
AUSTIN, MN 55912-2941
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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