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FAIRVIEW RIVERSIDE PHARMACY
DSH240080 UNIVERSITY OF MINNESOTA MEDICAL CENTER
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Covered Entity Details
Entity Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240080
Entity Address
500 HARVARD ST. SE
MINNEAPOLIS, MN 55455
Medicare Provider Number
240080
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW RIVERSIDE PHARMACY
Pharmacy Address
606 24TH AVENUE SOUTH
MINNEAPOLIS, MN 55454
Pharmacy Comments
Contract Details
Approval Date
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
10/1/2016
Contract Comments
Contacts
Covered Entity Signing Official
Daniel M. Fromm, Sr. VP and CFO, Fairview Health Services
(612) 672-4976
Contract Pharmacy Representative
Fairview Health Services
Robert Beacher, President, Fairview Pharmacy Services LLC
(612) 672-7047
Signed By Date
1/30/2013
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