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MERCY HOSPITAL PHC
DSH240038F United Hospital
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Covered Entity Details
Entity Name
United Hospital
Subdivision Name
Minnesota Perinatal Physicians - United
Type
Disproportionate Share Hospital
340B ID
DSH240038F
Entity Address
347 North Smith Avenue
204
Saint 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
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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