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ALLINA HEALTH PIPER BUILDING PHARMACY
DSH240038D United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Nasseff Heart Center - Spine/PC/MH
Type
Disproportionate Share Hospital
340B ID
DSH240038D
Entity Address
255 North Smith
3rd Floor
St Paul, MN 55102
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 PIPER BUILDING PHARMACY
Pharmacy Address
913 E 26TH ST
1ST FLOOR PIPER BUILDING
MINNEAPOLIS, MN 55404
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
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 Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
4/14/2021
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