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MERCY HOSPITAL PHC
DSH240038 United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240038
Entity Address
333 North Smith Ave
St Paul, MN 55102
Medicare Provider Number
240038
Participating Start Date
10/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
MERCY HOSPITAL PHC
Pharmacy Address
4050 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433-2522
Pharmacy Comments
Contract Details
Approval Date
1/20/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Gustafson, Director, Finance
(651) 241-8495
Contract Pharmacy Representative
Jill Strykowski, Director of Pharmacy
(763) 236-4137
Signed By Date
1/20/2017
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