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ALLINA HEALTH MERCY PHARMACY
DSH240020 CAMBRIDGE MEDICAL CENTER
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Covered Entity Details
Entity Name
CAMBRIDGE MEDICAL CENTER
Subdivision Name
Hospital
Type
Disproportionate Share Hospital
340B ID
DSH240020
Entity Address
701 SOUTH DELLWOOD
CAMBRIDGE, MN 55008
Medicare Provider Number
240020
Participating Start Date
10/1/2019
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH MERCY PHARMACY
Pharmacy Address
11850 BLACKFOOT ST. NW
STE 190
COON RAPIDS, MN 55433
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
4/1/2024
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 Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
10/4/2023
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