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ALLINA HEALTH FARIBAULT PHARMACY
DSH240038 United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240038
Entity Address
333 North Smith Ave
St Paul, MN 55102
Medicare Provider Number
240038
Participating Start Date
10/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH FARIBAULT PHARMACY
Pharmacy Address
200 STATE AVE
FARIBAULT, MN 55021
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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