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HCMC BLUE PHARMACY
TB55415 Hennepin County
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Covered Entity Details
Entity Name
Hennepin County
Subdivision Name
Hennepin County Public Health Clinic
Type
Tuberculosis
340B ID
TB55415
Entity Address
525 Portland Avenue
MC 952
Minneapolis, MN 55415
Grant Number
1NU52PS910308
Participating Start Date
4/1/2013
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
HCMC BLUE PHARMACY
Pharmacy Address
HENNEPIN COUNTY MEDICAL CENTER
B1 PHARMACY
701 PARK AVE
MINNEAPOLIS, MN 55415
Pharmacy Comments
Contract Details
Approval Date
7/11/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Agreement registered in error
Contacts
Covered Entity Signing Official
Paula Nelson, Clinic Operations Manager
(612) 348-3283
Contract Pharmacy Representative
Hennepin County Medical Center
Michael Pitzl, Pharmacy Director
(612) 873-9917
Signed By Date
7/11/2014
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