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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240038N United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Courage Kenny Sports & Physical Therapy - Apple Valley
Type
Disproportionate Share Hospital
340B ID
DSH240038N
Entity Address
14655 Galaxie Avenue
160
Apple Valley, MN 55124-8575
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
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
10/14/2019
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
10/14/2019
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