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MAYO CLINIC PHARMACY
DSH240043 MAYO CLNIC HLTH SYS-ALBRT LEA AUSTIN
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Covered Entity Details
Entity Name
MAYO CLNIC HLTH SYS-ALBRT LEA AUSTIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240043
Entity Address
1000 1ST DRIVE NW
AUSTIN, MN 55912
Medicare Provider Number
240043
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
MAYO CLINIC PHARMACY
Pharmacy Address
3551 Commercial Dr SW
Rochester, MN 55902
Pharmacy Comments
Contract Details
Approval Date
4/22/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Travis C. Paul, Regional Chair of Administration SWMN
(608) 392-9716
Contract Pharmacy Representative
Mayo Clinic
Jordan Daniel Haag, Associate Chief Pharmacy Officer
(507) 284-5722
Signed By Date
4/15/2025
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