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FAIRVIEW HOME INFUSION
RRC240210-00 HEALTHEAST ST JOHNS HOSPITAL
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Covered Entity Details
Entity Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC240210-00
Entity Address
1575 BEAM AVE
MAPLEWOOD, MN 55109-1126
Medicare Provider Number
240210
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
FAIRVIEW HOME INFUSION
Pharmacy Address
711 B KASOTA AVENUE SE
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
4/16/2025
Contract Begin Date
7/1/2025
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
4/15/2025
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