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FAIRVIEW HOME INFUSION
DSH240210 HEALTHEAST ST JOHNS HOSPITAL
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Covered Entity Details
Entity Name
HEALTHEAST ST JOHNS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240210
Entity Address
1575 BEAM AVENUE
MAPLEWOOD, MN 55109
Medicare Provider Number
240210
Participating Start Date
10/1/2014
Last Recertification Date
8/26/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
FAIRVIEW HOME INFUSION
Pharmacy Address
711 B KASOTA AVENUE SE
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Catherine Barr, SVP/COO
(651) 232-2185
Contract Pharmacy Representative
Fairview Health Services
Robert Beacher, President, Fairview Pharmacy Services LLC
(612) 672-7047
Signed By Date
10/16/2017
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