Contract Pharmacy Details

ALLINA HEALTH APPLE VALLEY PHARMACY
CAH241378-01 NEW ULM MEDICAL CENTER

Entity Name

NEW ULM MEDICAL CENTER

Subdivision Name

NEW ULM MEDICAL CENTER- CLINIC

Type

Critical Access Hospital

340B ID

CAH241378-01

Entity Address

1217 8TH Street N
NEW ULM, MN 56073

Medicare Provider Number

241378

Outpatient Facility Provider Number

Participating Start Date

8/6/2010

Last Recertification Date

8/16/2023

Pharmacy Name

ALLINA HEALTH APPLE VALLEY PHARMACY

Pharmacy Address

14655 GALAXIE AVE
APPLE VALLEY, MN 55124-8602

Pharmacy Comments

Approval Date

3/27/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

4/1/2024

Contract Comments

Covered Entity Signing Official

Tony M Collins-Kwong, Director, Strategic Sourcing and Services, Pharmacy Services
(612) 262-4785

Signed By Date

3/27/2024

Contract Pharmacy Representative

Allina Health
Tim J Gallagher, Director, Retail and Specialty Pharmacy
(612) 262-6654