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ALLINA HEALTH WESTHEALTH PHARMACY
DSH240038M United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Courage Kenny Rehab Associates (Sister Kenny Rehab Associates)
Type
Disproportionate Share Hospital
340B ID
DSH240038M
Entity Address
280 North Smith Avenue
220
St Paul, MN 55102-2459
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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