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ALLINA HEALTH MERCY PHARMACY
CAH241378-04 NEW ULM MEDICAL CENTER
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Covered Entity Details
Entity Name
NEW ULM MEDICAL CENTER
Subdivision Name
Courage Kenny Rehabilitation Institute - Winthrop
Type
Critical Access Hospital
340B ID
CAH241378-04
Entity Address
211 East 2nd St
Winthrop, MN 55396-2390
Medicare Provider Number
241378
Outpatient Facility Provider Number
Participating Start Date
1/1/2022
Last Recertification Date
8/13/2024
Entity Termination Date
4/1/2025
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
3/27/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
4/1/2024
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
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
3/27/2024
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