Contract Pharmacy Details

PARK NICOLLET PHARMACY
DSH240187 HUTCHINSON HEALTH

Covered Entity Details

Entity Name

HUTCHINSON HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH240187

Entity Address

1095 HIGHWAY 15 SOUTH
HUTCHINSON, MN 55350

Medicare Provider Number

240187

Participating Start Date

7/1/2017

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

PARK NICOLLET PHARMACY

Pharmacy Address

3850 PARK NICOLLET BLVD.
ST LOUIS PARK, MN 55416

Pharmacy Comments

Contract Details

Approval Date

1/14/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/1/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Pamela J. Larson, CFO
(320) 484-4472

Contract Pharmacy Representative

HealthPartners
David L. Busch, VP of Pharmacy Operations
(952) 967-5049

Signed By Date

1/14/2020

340B Drug Pricing Program Database