State of Minnesota Payments to Practitioners Reporting Form - 2007
Wholesaler/Manufacturer Name Allergan, Inc.
Wholesaler/Manufacturer Address 2525 Dupont Drive, Irvine, California 92630
Minnesota License Number 361246-6
Name of Individual Completing Report Nancy M. Kusicki, Associate Paralegal, Litigation & Compliance
Phone number (714) 246-5545
Background information and instructions: Minnesota Statutes require wholesale drug distributors and manufacturers to file with the Board of Pharmacy an
prescribe drugs. Pharmacists are not practitioners). The payments that must be reported include: honoraria and payments for expenses of a practitioner who
services of a practitioner working on a genuine research project. (See Minnesota Statutes 151.461 and 151.47). The report must identify the specific reason f
and expenses for speaking", "payment for research consultation", etc.). Do not list general reasons (e.g. "payments for consultation", "payments for services
return it to the Board either attached to an e-mail (Pharmacy.Board@state.mn.us) or copied onto a CD_ROM.
Professional designation (e.g.
LAST NAME OF PRACTITIONER FIRST NAME OF PRACTITIONER
MD), if any
Andrews James MD
Andrews James MD
Andrews James MD
Brennan Connie CNP, RN
Carney Patrick MD
Carney Patrick MD
Carpel Emmett MD
Christensen Jeffrey MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Chu Ralph MD
Dang Thanh MD
Dang Thanh MD
Davidson Lisa MD
Davidson Lisa MD
Davis Elizabeth MD, FACS
Davis Elizabeth MD, FACS
Dykstra Dennis MD
Dykstra Dennis MD
Ekstrom Erik MD
Ekstrom Erik MD
Ekstrom Erik MD
Ekstrom Erik MD
Fasching Michael MD
Fasching Michael MD
George Pierre MD
Gullingsrud Eugene MD
Huang Andrew MD
Kobrin Jerry MD
Leigh Nathan MD
Oehlke Sandra CRNP
Philbin Michael MD
Robin Steven MD
Samuelson Thomas MD
Szachowicz Edward MD
Szachowicz Edward MD
Taylor Gerald PA
Vogt Michael MD
Vogt Michael MD
Vogt Michael MD
Vogt Michael MD
Compliance
nufacturers to file with the Board of Pharmacy an annual report identifying certain payments made to practitioners. (Practitioners are those licensed health professsionals wh
nd payments for expenses of a practitioner who serves as a speaker at a professional or educational conference or meeting; and compensation for substantial professional o
7). The report must identify the specific reason for payments totalling $100 or more. In the column marked "Specific reason for payment", please list the reason for the paym
ments for consultation", "payments for services rendered"). Reports filed under this provision are public data. Reports must be filed in an electronic format, so please fill out th
.
ADDRESS OF PRACTITIONER PAYMENT INFORMATIO
Street Address City State Zip Code Value of Payment
624 N. Woodland Drive Fergus Falls MN 56537 1,500.00
624 N. Woodland Drive Fergus Falls MN 56537 1,544.00
624 N. Woodland Drive Fergus Falls MN 56537 1,500.00
3955 Park Lawn Avenue Edina MN 55435 1,000.00
7373 France Avenue South, Suite 408 Edina MN 55435 750.00
7373 France Avenue South, Suite 408 Edina MN 55435 1,500.00
5100 Gamble Drive , Suite 100 St. Louis Park MN 55416 500.00
710 East 24th Street, Suite 402 Minneapolis MN 55404 550.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 1,500.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 10,000.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 6,250.00
7760 France Ave South, Suite 140 Edina MN 55435 10,000.00
206 Pine St. Monticello MN 55362 1,000.00
206 Pine St. Monticello MN 55362 1,027.65
1230 East Main Street Mankato MN 56002 1,000.00
1230 East Main Street Mankato MN 56002 1,200.00
2645 Arcola Lane Wayzata MN 55391 1,000.00
2645 Arcola Lane Wayzata MN 55391 10,000.00
5405 Oaklawn Avenue Edina MN 55424 2,000.00
5405 Oaklawn Avenue Edina MN 55424 2,000.00
2614 Irving Avenue South Minneapolis MN 55408 1,000.00
2614 Irving Avenue South Minneapolis MN 55408 1,000.00
2614 Irving Avenue South Minneapolis MN 55408 1,000.00
2614 Irving Avenue South Minneapolis MN 55408 1,000.00
2805 Campus Dr., Suite 335 Plymouth MN 55441 200.00
2805 Campus Dr., Suite 335 Plymouth MN 55441 150.00
679 Lincoln Avenue St. Paul MN 55105 1,000.00
7450 France Ave S #100 Edina MN 55435 550.00
516 Delaware St., Ste 9-240 Phillip Minneapolis MN 55455 2,125.00
401 Phalen Blvd. St. Paul MN 55130 550.00
6525 France Ave So, Suite 300 Edina MN 55435 310.00
910 Medical Place, E. 26th St. Minneapolis MN 55404 750.00
6525 France Ave So, Suite 300 Edina MN 55435 310.00
25 Ottawa Ave N Golden Valley MN 55422 550.00
4700 Old Kent Road Deephaven MN 55331 3,000.00
7373 France, Suite 310 Edina MN 55435 749.00
7373 France, Suite 310 Edina MN 55435 288.92
3290 65th Avenue SE St. Cloud MN 56303 750.00
2481 Fieldstone Curve Woodbury MN 55129 20,885.00
2481 Fieldstone Curve Woodbury MN 55129 200.00
2481 Fieldstone Curve Woodbury MN 55129 700.00
2481 Fieldstone Curve Woodbury MN 55129 4,935.00
ose licensed health professsionals who are authorized to
ensation for substantial professional or consulting
nt", please list the reason for the payment. (e.g. "honoraria
n electronic format, so please fill out this spreadsheet and
PAYMENT INFORMATION
Specific reason for payment
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Professional/Consulting Services
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Faculty Honorarium/Expenses
Professional/Consulting Services
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Faculty Honorarium/Expenses
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services
Professional/Consulting Services