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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240071A Allina Health Faribault Medical Center
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Covered Entity Details
Entity Name
Allina Health Faribault Medical Center
Subdivision Name
Courage Kenny Rehab Associates
Type
Disproportionate Share Hospital
340B ID
DSH240071A
Entity Address
35 State Ave
Faribault, MN 55021-6368
Medicare Provider Number
240071
Outpatient Facility Provider Number
Participating Start Date
1/1/2022
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH HEART HOSPITAL PHARMACY
Pharmacy Address
920 E 28TH ST STE H1254
MINNEAPOLIS, MN 55407
Pharmacy Comments
Contract Details
Approval Date
12/2/2023
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
12/2/2023
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