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WALGREEN CO.
DSH240004 HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
HENNEPIN HEALTHCARE SYSTEM, INC. - HENNEPIN COUNTY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240004
Entity Address
701 PARK AVE SOUTH
MINNEAPOLIS, MN 55415
Medicare Provider Number
240004
Participating Start Date
12/1/1992
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #21365
3001A NICOLLET AVE
MINNEAPOLIS, MN 55408
Pharmacy Comments
Contract Details
Approval Date
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/17/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Julie Lynn Flaschenriem, Chief Information Officer
(612) 873-9290
Contract Pharmacy Representative
Hennepin Healthcare Systems, Inc. - HCMC
Heather Anderson, Pharmacy Revenue Manager
(612) 873-3225
Signed By Date
10/12/2022
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