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ALLINA HEALTH MERCY PHARMACY
DSH240038AG United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Courage Kenny Rehabilitation Institute - Hastings - Nininger Road - PT
Type
Disproportionate Share Hospital
340B ID
DSH240038AG
Entity Address
1285 Nininger Rd
STE L001
Hastings, MN 55033-1086
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
10/1/2023
Last Recertification Date
8/12/2024
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
3/28/2024
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
3/28/2024
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