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ALLINA HEALTH WESTHEALTH PHARMACY
DSH240038N United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Courage Kenny Sports & Physical Therapy - Apple Valley
Type
Disproportionate Share Hospital
340B ID
DSH240038N
Entity Address
14655 Galaxie Avenue
160
Apple Valley, MN 55124-8575
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
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
12/1/2023
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
Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654
Signed By Date
12/1/2023
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