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WAL-MART PHARMACY 10-2274
DSH240057 ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240057
Entity Address
800 EAST 28TH STREET
MINNEAPOLIS, MN 55407
Medicare Provider Number
240057
Participating Start Date
10/1/2015
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2274
Pharmacy Address
200 S.W. 12TH STREET
FOREST LAKE, MN 55025
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
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
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/11/2023
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