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ALLINA HEALTH NEW ULM PHARMACY
DSH240038P United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Allina Health Minneapolis Heart Institute - St. Paul Vascular Clinic
Type
Disproportionate Share Hospital
340B ID
DSH240038P
Entity Address
225 North Smith Avenue
500
St. Paul, MN 55102
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
1/1/2015
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH NEW ULM PHARMACY
Pharmacy Address
1217 8TH ST N STE 1010
NEW ULM, MN 56073-1552
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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