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ALLINA HEALTH PIPER BUILDING PHARMACY
DSH240020C CAMBRIDGE MEDICAL CENTER
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Covered Entity Details
Entity Name
CAMBRIDGE MEDICAL CENTER
Subdivision Name
Courage Kenny Sports & Physical Therapy-Isanti
Type
Disproportionate Share Hospital
340B ID
DSH240020C
Entity Address
300 5th Ave NE
200
Isanti, MN 55040-7480
Medicare Provider Number
240020
Outpatient Facility Provider Number
Participating Start Date
1/1/2022
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH PIPER BUILDING PHARMACY
Pharmacy Address
913 E 26TH ST
1ST FLOOR PIPER BUILDING
MINNEAPOLIS, MN 55404
Pharmacy Comments
Contract Details
Approval Date
3/27/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
4/1/2024
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
3/27/2024
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