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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240038P United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Allina Health Minneapolis Heart Institute - St. Paul Vascular Clinic
Type
Disproportionate Share Hospital
340B ID
DSH240038P
Entity Address
225 North Smith Avenue
500
St. Paul, MN 55102
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
1/1/2015
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
Phillip J. Krolik, VP, Finance
(651) 241-8827
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
10/8/2019
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