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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240057F ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Courage Kenny Rehab Associates Pain Program
Type
Disproportionate Share Hospital
340B ID
DSH240057F
Entity Address
3915 Golden Valley Road
Golden Valley, MN 55422-4249
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
10/1/2015
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH HEART HOSPITAL PHARMACY
Pharmacy Address
920 E 28TH ST STE H1254
MINNEAPOLIS, MN 55407
Pharmacy Comments
Contract Details
Approval Date
10/2/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
1/1/2024
Contract Comments
Contacts
Covered Entity Signing Official
Brian Weinreis, Chief Financial Officer
(612) 863-1920
Contract Pharmacy Representative
allina
Ann Byre, Director of Pharmacy Services
(612) 262-5992
Signed By Date
10/2/2015
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