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ALLINA HEALTH APPLE VALLEY PHARMACY
DSH240038N United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Courage Kenny Sports & Physical Therapy - Apple Valley
Type
Disproportionate Share Hospital
340B ID
DSH240038N
Entity Address
14655 Galaxie Avenue
160
Apple Valley, MN 55124-8575
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 APPLE VALLEY PHARMACY
Pharmacy Address
14655 GALAXIE AVE
APPLE VALLEY, MN 55124-8602
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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