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FAIRVIEW HOME INFUSION
DSH240063 HEALTHEAST ST JOSEPHS HOSPITAL
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Covered Entity Details
Entity Name
HEALTHEAST ST JOSEPHS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240063
Entity Address
45 WEST 10TH STREET
ST PAUL, MN 55102
Medicare Provider Number
240063
Participating Start Date
10/1/2014
Last Recertification Date
9/13/2021
Entity Termination Date
7/1/2022
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
7/1/2022
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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