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FAIRVIEW SPECIALTY SERVICES PHARMACY
DSH240106 REGIONS HOSPITAL
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Covered Entity Details
Entity Name
REGIONS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240106
Entity Address
640 JACKSON ST.
ST. PAUL, MN 55101
Medicare Provider Number
240106
Participating Start Date
12/1/1992
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW SPECIALTY SERVICES PHARMACY
Pharmacy Address
711 KASOTA AVENUE SE, SUITE A
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
HEIDI CONRAD, CFO
(651) 254-0900
Contract Pharmacy Representative
Fairview
Tim Affeldt, VP of Specialty/Infusion Operations
(612) 672-5127
Signed By Date
1/13/2020
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