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ALLINA HEALTH HEART HOSPITAL PHARMACY
DSH240057E ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Minnesota Perinatal Physicians Edina / SW Perinatal Ultrasound
Type
Disproportionate Share Hospital
340B ID
DSH240057E
Entity Address
6525 France Ave Sout
205
Edina, MN 55435-2176
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
10/1/2015
Last Recertification Date
9/10/2021
Entity Termination Date
7/1/2022
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
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
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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