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ALLINA HEALTH WESTHEALTH PHARMACY
DSH240038Q United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Allina Health Mental Health - United Clinic
Type
Disproportionate Share Hospital
340B ID
DSH240038Q
Entity Address
280 Smith Avenue N
350 & 450
Saint Paul, MN 55102-2481
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
1/1/2021
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH WESTHEALTH PHARMACY
Pharmacy Address
2855 CAMPUS DR
PLYMOUTH, MN 55441
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
4/10/2023
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