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ALLINA HEALTH MERCY PHARMACY
DSH240057AN ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians Abbott
Type
Disproportionate Share Hospital
340B ID
DSH240057AN
Entity Address
902 E 26th St
1700
Minneapolis, MN 55404-4514
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
1/1/2022
Last Recertification Date
8/12/2024
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
11/29/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
1/1/2024
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
11/29/2023
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