340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
ALLINA HEALTH MERCY PHARMACY
DSH240057H ABBOTT NORTHWESTERN HOSPITAL
Print
Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Courage Kenny Rehab Associates
Type
Disproportionate Share Hospital
340B ID
DSH240057H
Entity Address
7373 France Avenue S
Suite 204
Edina, MN 55435
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
10/1/2015
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH MERCY PHARMACY
Pharmacy Address
11850 BLACKFOOT ST. NW
STE 190
COON RAPIDS, MN 55433
Pharmacy Comments
Contract Details
Approval Date
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Ann Rice, President
(612) 863-7737
Contract Pharmacy Representative
Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
4/12/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session