Contract Pharmacy Details

ALLINA HEALTH MERCY PHARMACY
DSH240038M United Hospital

Covered Entity Details

Entity Name

United Hospital

Subdivision Name

Courage Kenny Rehab Associates (Sister Kenny Rehab Associates)

Type

Disproportionate Share Hospital

340B ID

DSH240038M

Entity Address

280 North Smith Avenue
220
St Paul, MN 55102-2459

Medicare Provider Number

240038

Outpatient Facility Provider Number

Participating Start Date

10/1/2013

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

340B Drug Pricing Program Database