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ALLINA HEALTH WESTHEALTH PHARMACY
DSH240057A ABBOTT NORTHWESTERN HOSPITAL
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Covered Entity Details
Entity Name
ABBOTT NORTHWESTERN HOSPITAL
Subdivision Name
Abbott Northwestern WestHealth Emergency Dept
Type
Disproportionate Share Hospital
340B ID
DSH240057A
Entity Address
2855 Campus Drive
Plymouth, MN 55441
Medicare Provider Number
240057
Outpatient Facility Provider Number
Participating Start Date
1/1/2019
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ALLINA HEALTH WESTHEALTH PHARMACY
Pharmacy Address
2855 CAMPUS DR
PLYMOUTH, MN 55441
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
7/1/2018
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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