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ALLINA HEALTH RITCHIE PHARMACY
DSH240038B United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Day Surgery Center
Type
Disproportionate Share Hospital
340B ID
DSH240038B
Entity Address
310 North Smith Ave
200
St Paul, MN 55102
Medicare Provider Number
240038
Outpatient Facility Provider Number
Participating Start Date
10/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH RITCHIE PHARMACY
Pharmacy Address
280 NORTH SMITH AVE
SUITE 120
ST PAUL, MN 55102
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
John P. Bien, CFO
(651) 241-8827
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
10/14/2013
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