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FAIRVIEW SPECIALTY SERVICES PHARMACY
DSH240001 North Memorial Health Care
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Covered Entity Details
Entity Name
North Memorial Health Care
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH240001
Entity Address
3300 Oakdale Ave North
Robbinsdale, MN 55422
Medicare Provider Number
240001
Participating Start Date
1/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FAIRVIEW SPECIALTY SERVICES PHARMACY
Pharmacy Address
711 KASOTA AVENUE SE, SUITE A
MINNEAPOLIS, MN 55414
Pharmacy Comments
Contract Details
Approval Date
1/15/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin J. Croston, CEO
(763) 581-4702
Contract Pharmacy Representative
Fairview Health Services
Robert Beacher, President, Fairview Pharmacy Services LLC
(612) 672-7047
Signed By Date
1/15/2018
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