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MERCY HOSPITAL PHC
DSH240038C United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Allina Health Minneapolis Heart Institute - United Hospital
Type
Disproportionate Share Hospital
340B ID
DSH240038C
Entity Address
225 North Smith Avenue
100
St Paul, MN 55102-2533
Medicare Provider Number
240038
Outpatient Facility Provider Number
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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