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ALLINA HEALTH NEW ULM PHARMACY
DSH240057Y ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Abbott Northwestern Kidney Transplant Providers
Type
Disproportionate Share Hospital
340B ID
DSH240057Y
Entity Address
920 E. 28th Street
540
Minneapolis, MN 55407
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
1/1/2020
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH NEW ULM PHARMACY
Pharmacy Address
1217 8TH ST N STE 1010
NEW ULM, MN 56073-1552
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
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