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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240115A MERCY HOSPITAL
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Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians
Type
Disproportionate Share Hospital
340B ID
DSH240115A
Entity Address
3960 Coon Rapids Blvd NW
220
Coon Rapids, MN 55433-2589
Medicare Provider Number
240115
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH HEART HOSPITAL PHARMACY
Pharmacy Address
920 E 28TH ST STE H1254
MINNEAPOLIS, MN 55407
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Paula Inman, Director of Finance
(763) 236-2176
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
10/8/2019
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