340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
FAIRVIEW PHARMACY MAPLE GROVE
DSH240080 UNIVERSITY OF MINNESOTA MEDICAL CENTER
Print
Covered Entity Details
Entity Name
UNIVERSITY OF MINNESOTA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240080
Entity Address
500 HARVARD ST. SE
MINNEAPOLIS, MN 55455
Medicare Provider Number
240080
Participating Start Date
7/1/2006
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW PHARMACY MAPLE GROVE
Pharmacy Address
14500 99TH AVENUE NORTH SUITE 1A029
MAPLE GROVE, MN 55369
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Trudi Noel Trysla, Chief Legal Officer
(612) 672-6382
Contract Pharmacy Representative
Fairview Pharmacy Services
John Pastor, System VP Pharmacy and Respiratory Care
(612) 672-5153
Signed By Date
4/11/2024
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session