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ALLINA HEALTH PIPER BUILDING PHARMACY
DSH240038L United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
United Pain Management Clinic
Type
Disproportionate Share Hospital
340B ID
DSH240038L
Entity Address
255 North Smith Avenue
100
St Paul, MN 55102-2518
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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