State of Minnesota Payments to Practitioners Reporting Form - 2007
Wholesaler/Manufacturer Name BOEHRINGER INGELHEIM PHARMACEUTICALS INC.
Wholesaler/Manufacturer Address 900 RIDGEBURY ROAD, RIDGEFIELD,CT 06877
Minnesota License Number 460191-3
Name of Individual Completing Report Kathleen Hirst
Phone number 203-798-9988
Background information and instructions: Minnesota Statutes require wholesale drug distributors and manufacturers to file with the Board of Pharmacy an annual report identifying certain payments made to practitioners. (Practitioners are those licensed health professsionals who are
authorized to prescribe drugs. Pharmacists are not practitioners). The payments that must be reported include: honoraria and payments for expenses of a practitioner who serves as a speaker at a professional or educational conference or meeting; and compensation for substantial
professional or consulting 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 for payments totalling $100 or more. In the column marked "Specific reason for payment", please list the
reason for the payment. (e.g. "honoraria and expenses for speaking", "payment for research consultation", etc.). Do not list general reasons (e.g. "payments 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 this spreadsheet and 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. ADDRESS OF PRACTITIONER PAYMENT INFORMATION
LAST NAME OF PRACTITIONER FIRST NAME OF PRACTITIONER
MD), if any
Street Address City State Zip Code Value of Payment Specific reason for payment
Altafullah Irfan MD 2520 Thoroughbred Ln Orono MN 55356 26,667.22 Fee for Service/Reimbursement
Blazar Bruce MD 4350 Sussex Road Golden Valley MN 55416 3,088.88 Fee for Service/Reimbursement
Brauer Ernesto MD 255 Smith Ave N Saint Paul MN 55102 2,004.42 Fee for Service/Reimbursement
Crisostomo Edward MD 1001 E Superior St Duluth MN 55802 6,420.00 Fee for Service/Reimbursement
Dahlquist Neil MD 360 Sherman St Saint Paul MN 55102 50,036.06 Fee for Service/Reimbursement
Davidson Lisa MD PO Box 2052 Mankato MN 56002 4,076.09 Fee for Service/Reimbursement
Elhalawani Samy DO 255 Smith Ave N Saint Paul MN 55102 4,040.46 Fee for Service/Reimbursement
Fox Jean MD 15700 37th Ave N Plymouth MN 55446 4,154.20 Fee for Service/Reimbursement
Goodroad Brian CNP 2545 Chicago Ave Minneapolis MN 55404 3,336.00 Fee for Service/Reimbursement
Holm Mark MD 108 Mill Creek Cir Saint Cloud MN 56303 1,000.00 Fee for Service/Reimbursement
Ingbar David MD 3800 York Ave S Minneapolis MN 55410 6,760.33 Fee for Service/Reimbursement
Kamman Lee MD 1575 Beam Ave Maplewood MN 55109 4,000.00 Fee for Service/Reimbursement
Keenan Joseph MD 7100 Tralee Dr Edina MN 55439 6,978.63 Fee for Service/Reimbursement
McEvoy Charlene MD 401 Phalen Blvd Saint Paul MN 55101 2,100.74 Fee for Service/Reimbursement
Monga Manoj MD 1904 W 49th St Minneapolis MN 55419 59,071.04 Fee for Service/Reimbursement
Muter Edward MD 205 Wabasha St S Saint Paul MN 55107 2,085.72 Fee for Service/Reimbursement
Nahum Avi MD 205 Wabasha St S Saint Paul MN 55107 2,074.94 Fee for Service/Reimbursement
Nelson Merlin MD 101 Willmar Ave SW Willmar MN 56201 35,761.87 Fee for Service/Reimbursement
Niewoehner Dennis MD VA Medical Center Minneapolis MN 55417 49,694.50 Fee for Service/Reimbursement
Nordahl Thomas MD 1200 6th Ave N Saint Cloud MN 56303 4,077.00 Fee for Service/Reimbursement
Pratt Alan MD 3171 Storer Valley Rd. Houston MN 55943 2,500.00 Fee for Service/Reimbursement
Rose Cary MD 5015 Terraceview Ln N Plymouth MN 55446 48,252.75 Fee for Service/Reimbursement
Rubins Jeffrey MD 1 Veterans Dr 111 Minneapolis MN 55417 10,177.70 Fee for Service/Reimbursement
Seifert Randall MD 7937 Agency Narrows Dr NWWalker MN 56484 11,856.22 Fee for Service/Reimbursement
Stang Mark MD 7450 France Ave S Edina MN 55435 1,060.22 Fee for Service/Reimbursement
Wright Patrick MD 920 E 28th St Minneapolis MN 55407 21,785.92 Fee for Service/Reimbursement
Zarama Mario MD 3483 Williamsburg Pkwy Woodbury MN 55129 4,106.10 Fee for Service/Reimbursement
Zavoral James MD 6545 France Ave S Minneapolis MN 55435 6,042.42 Fee for Service/Reimbursement