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ALLINA HEALTH NEW ULM PHARMACY
DSH240115A MERCY HOSPITAL
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Covered Entity Details
Entity Name
MERCY HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians
Type
Disproportionate Share Hospital
340B ID
DSH240115A
Entity Address
3960 Coon Rapids Blvd NW
220
Coon Rapids, MN 55433-2589
Medicare Provider Number
240115
Outpatient Facility Provider Number
Participating Start Date
10/1/2019
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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