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MERCY HOSPITAL PHC
DSH240020 CAMBRIDGE MEDICAL CENTER
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Covered Entity Details
Entity Name
CAMBRIDGE MEDICAL CENTER
Subdivision Name
Hospital
Type
Disproportionate Share Hospital
340B ID
DSH240020
Entity Address
701 SOUTH DELLWOOD
CAMBRIDGE, MN 55008
Medicare Provider Number
240020
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
MERCY HOSPITAL PHC
Pharmacy Address
4050 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433-2522
Pharmacy Comments
Contract Details
Approval Date
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kelly John Spratt, President
(763) 688-7804
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
10/8/2019
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