State of Minnesota Dba Form - Excel

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State of Minnesota Dba Form document sample

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							State of Minnesota Payments to Practitioners Reporting Form - 2008

Wholesaler/Manufacturer Name                        Pfizer Inc
Wholesaler/Manufacturer Address                     235 East 42nd Street, New York, NY 10017
Minnesota License Number                            459566-3
Name of Individual Completing Report                Humberto Leon, Corp Counsel
Phone number                                        212-733-0066


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                                     ADDRESS OF PRACTITIONER                                                            PAYMENT INFORMATION
          LAST NAME OF PRACTITIONER                  FIRST NAME OF PRACTITIONER
                                                                                                 (e.g. MD), if any
                                                                                                                           Street Address              City                        State          Zip Code                 Value of Payment            Specific reason for payment
                                                                                                                                                                                                                                            Speaking Fee and related
Aaronson                                            Michael                               MD                               20 2ND ST NE UNIT 509
                                                                                                                                              Minneapolis                          MN             55413                          $26,477.30 expenses

                                                                                                                                                                                                                                            Speaking Fee and related
                                                                                                                                                                                                                                            expenses; Professional Consulting
Ahluwalia                                           Jasjit                                MD                               5036 BRUCE AVE              Minneapolis                 MN             55424                          $26,855.15 Fees and related expenses

                                                                                                                                                                                                                                                Speaking Fee and related
                                                                                                                                                                                                                                                expenses; Professional Consulting
Altafullah                                          Irfran                                MD                                              Long
                                                                                                                           2520 THOROUGHBRED LNLake                                MN             55356                           $4,649.58     Fees and related expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Anderholm                                           David                                 MD                                                Nisswa
                                                                                                                           23312 DUTCHMANS BLF                                     MN             56468                           $3,592.33     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Andrews                                             James                                 DO                                               Fergus Falls
                                                                                                                           624 N WOODLAND DR                                       MN             56537                           $3,892.85     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Baken                                               Leslie                                MD                               4316 GLENCREST RDMinneapolis                            MN             55416                           $2,128.03     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Bambenek                                            Gregory                               MD                                                  703
                                                                                                                           325 S LAKE AVE STE Duluth                               MN             55802                              $125.97    expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Bank                                                Alan                                  MD                               SMITH AVE N                 Saint Paul                  MN             55102                           $1,000.00     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Beaver                                              Gary                                  DO                               400 E 3RD ST                Duluth                      MN             55805                           $5,294.86     expenses

                                                                                                                                                                                                                                                Speaking Fee and related
                                                                                                                                                                                                                                                expenses; Professional Consulting
Belgrade                                            Miles                                 MD                                               Minneapolis
                                                                                                                           PAIN MANAGEMENT CENTER                                  MN             55454                          $12,368.45     Fees and related expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Bentz                                               Steven                                MD                                                  Minneapolis
                                                                                                                           10218 MISSISSIPPI BLVD NW                               MN             55433                              $631.06    expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Berger                                              Ines                                  MD                               2863 24TH ST NW             Rochester                   MN             55901                              $375.09    expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Billups                                             Kevin                                 MD                               5505 DUFFERIN DR Savage                                 MN             55378                           $7,163.64     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Boelter                                             Christopher                           MD                                                Sartell
                                                                                                                           ADULT & PED. UROLOGY                                    MN             56377                           $2,509.55     expenses
                                                                                                                                                                                                                                                Speaking Fee and related
                                                                                                                                                                                                                                                expenses; Research Consulting
Brown                                               David                                 MD                                                  Minneapolis
                                                                                                                           910 E 26TH ST STE 325                                   MN             55404                           $2,015.87     Fees and related expenses
                                                                                                                                                                                                                                                Speaking Fee and related
Butwinick                                           Conrad                                MD                                                LN
                                                                                                                           12400 HUNTINGDON Hopkins                                MN             55305                           $2,771.05     expenses
                                                                                         Speaking Fee and related
Canoniero     Mariana     MD   221 1ST AVE NE APT Minneapolis
                                                  33            MN   55413     $1,250.00 expenses
                                                                                         Speaking Fee and related
Colon         Pastor      MD   46 EVERGREEN RD Saint Paul       MN   55110     $2,042.67 expenses
                                                                                         Professional Consulting Fees and
Cook          Bryan       MD   7066 STILLWATER BLVD NPaul
                                                 Saint          MN   55128      $183.96 related expenses
                                                                                         Speaking Fee and related
Dudek         Arkadiusz   MD   4411 MEADOWOOD CIR Paul
                                              Saint             MN   55127    $18,617.25 expenses

                                                                                           Speaking Fee and related
                                                                                           expenses; Professional Consulting
Duprez        Daniel      MD   7015 LANHAM LN     Minneapolis   MN   55439    $10,415.57   Fees and related expenses
                                                                                           Speaking Fee and related
El-Halawani   Samy        MD                   Saint Paul
                               11035 SWEETWATER PATH            MN   55129     $3,966.08   expenses
                                                                                           Speaking Fee and related
Erhard        Mark        MD   20660 LINWOOD RD Excelsior       MN   55331     $3,030.49   expenses
                                                                                           Speaking Fee and related
Gerten        Kimberly    MD   121 ASHLEY RD      Hopkins       MN   55343     $1,012.43   expenses

                                                                                           Speaking Fee and related
                                                                                           expenses; Professional Consulting
Goad          Eric        MD   5904 VIEW LN       Minneapolis   MN   55436     $4,357.98   Fees and related expenses
                                                                                           Speaking Fee and related
Graham        Kevin       MD                      Minneapolis
                               920 E 28TH ST STE 300            MN   55407     $4,175.95   expenses
                                                                                           Speaking Fee and related
Greatens      Todd        MD   13495 ELDER DRIVE Brainerd       MN   56401     $1,008.34   expenses
                                                                                           Professional Consulting Fees and
Grimm         Richard     MD   PO BOX 19619       Minneapolis   MN   55419    $10,147.38   related expenses
                                                                                           Speaking Fee and related
Groat         Ronald      MD                    Minnetonka
                               15320 MINNETONKA BLVD            MN   55345      $573.58    expenses
                                                                                           Speaking Fee and related
Groeschel     Ana         MD   6561 DEERWOOD LNCircle Pines     MN   55014     $3,199.68   expenses
                                                                                           Professional Consulting Fees and
Grothey       Axel        MD                     Rochester
                               819 FOX POINTE LN SW             MN   55902      $104.30    related expenses
                                                                                           Speaking Fee and related
Hadley        Stephen     MD                     Duluth
                               4000 EAST FIRST STREET           MN   55807     $1,710.37   expenses
                                                                                           Speaking Fee and related
Handa         Kushal      MD   1233 34TH ST NW    Bemidji       MN   56601    $15,651.65   expenses
                                                                                           Professional Consulting Fees and
Hays          J Taylor    MD                    Rochester
                               3239 FOX HOLLOW LN SW            MN   55902      $116.89    related expenses
                                                                                           Speaking Fee and related
Heiring       Jessica     MD   2046 ACORN CIR     Wayzata       MN   55391     $2,000.00   expenses
                                                                                           Speaking Fee and related
Hendrickson   Paul        MD                     Frazee
                               50737 E LAKE SEVEN RD            MN   56544     $2,024.56   expenses
                                                                                           Speaking Fee and related
Henry         Stephen     MD   610 30TH AVE W     Alexandria    MN   56308      $440.59    expenses
                                                                                           Speaking Fee and related
Henry         William     MD   701 PARK AVE #P5   Minneapolis   MN   55415     $2,730.72   expenses
                                                                                           Speaking Fee and related
Hess          Todd        MD   1724 COLFAX AVE S Minneapolis    MN   55403   $185,016.30   expenses

                                                                                         Speaking Fee and related
                                                                                         expenses; Professional Consulting
Hoffman       Neil        MD   9809 STJOHNS RD. Minnetonka      MN   55305     $3,047.50 Fees and related expenses
                                                                                         Speaking Fee and related
Hoiland       Christa     MD   11993 285TH ST     Lindstrom     MN   55045      $798.35 expenses
                                                                                        Speaking Fee and related
Holth        Byron      MD   11269 JEFFERSON HWY N
                                              Champlin           MN   55316     $750.00 expenses

                                                                                           Speaking Fee and related
                                                                                           expenses; Professional Consulting
Hurt         Richard    MD                    Rochester
                             2320 TELEMARK LN NW                 MN   55901   $20,064.85   Fees and related expenses
                                                                                           Speaking Fee and related
Ingenito     Allan      MD   5280 161ST AVE NW Anoka             MN   55303    $3,410.84   expenses
                                                                                           Speaking Fee and related
Kamman       Lee        MD                     S
                             2219 HIGH POINTE RDaint Paul        MN   55120    $3,014.85   expenses
                                                                                           Speaking Fee and related
Kassamali    Jamal      MD   604 9TH ST N         Virginia       MN   55792    $3,013.13   expenses
                                                                                           Speaking Fee and related
Katz         Harold     MD   3990 TROTTERS CT Saint Paul         MN   55123    $1,520.01   expenses
                                                                                           Speaking Fee and related
Keenan       Joseph     MD                    Minneapolis
                             1505 HAMPSHIRE AVE N                MN   55427    $2,074.21   expenses
                                                                                           Speaking Fee and related
Kemberling   Jason      MD   7953 S BAY CURV      Eden Prairie   MN   55347    $1,344.33   expenses
                                                                                           Speaking Fee and related
Khan         Asim       MD   2850 WESTRIDGE RDHopkins            MN   55305    $4,091.43   expenses
                                                                                           Speaking Fee and related
Khan         Muhammad   MD   483 POPLAR DR        Saint Paul     MN   55126    $3,022.53   expenses
                                                                                           Speaking Fee and related
Khetarpal    Suneel     MD                    RD
                             8200 MARSH CREEK Saint Paul         MN   55125    $2,195.28   expenses
                                                                                           Speaking Fee and related
Kline        Susan      MD   2269 HILLSIDE AVE Saint Paul        MN   55108    $3,732.66   expenses

                                                                                           Speaking Fee and related
                                                                                           expenses; Professional Consulting
Knudson      Dean       MD                    Minneapolis
                             2320 BROOKRIDGE AVE                 MN   55422    $7,841.42   Fees and related expenses
                                                                                           Speaking Fee and related
Kolodny      Luciano    MD   2587 ALPINE DR       Saint Paul     MN   55125    $3,177.24   expenses
                                                                                           Speaking Fee and related
Kriegler     Samuel     MD                      V
                             901 9TH ST N STE 315 irginia        MN   55792    $1,063.96   expenses
                                                                                           Speaking Fee and related
Locketz      Adam       MD                     Saint Paul
                             2140 VERMILLION BAY                 MN   55129    $3,198.08   expenses
                                                                                           Speaking Fee and related
Mcevoy       Charlene   MD   382 WINSLOW AVE Saint Paul          MN   55107    $5,500.00   expenses
                                                                                           Speaking Fee and related
                                                                                           expenses; Research Consulting
Miller       Bradley    MD   6728 PARTRIDGE PL Circle Pines      MN   55014    $1,688.56   Fees and related expenses
                                                                                           Professional Consulting Fees and
Mohan        Sushila    MD                     RD
                             8675 VALLEY CREEK Saint Paul        MN   55125    $1,183.96   related expenses
                                                                                           Speaking Fee and related
Morrison     Vicki      MD   4155 NORMA AVE       Saint Paul     MN   55112   $20,375.23   expenses
                                                                                           Professional Consulting Fees and
Nehra        Ajay       MD                    Rochester
                             5360 WEATHERHILL DR SW              MN   55902    $2,263.50   related expenses
                                                                                           Speaking Fee and related
Olson        Jennifer   MD   2700 SYLVAN RD S Hopkins            MN   55305    $1,015.47   expenses
                                                                                           Professional Consulting Fees and
Olson        Robert     MD   120 CHANCERY LN Mankato             MN   56001     $183.96    related expenses
                                                                                           Speaking Fee and related
Orr          William    MD                    S
                             3537 GREAT OAKS PL aint Paul        MN   55123   $10,669.78   expenses
                                                                                           Speaking Fee and related
Parry        Gareth     MD                    Minneapolis
                             516 DELAWARE ST SE RM 4-100         MN   55455    $2,646.83   expenses
                                                                                           Speaking Fee and related
Penovich     Patricia   MD                    RD
                             344 SALEM CHURCH Saint Paul         MN   55118    $1,507.28   expenses
                                                                                                Speaking Fee and related
                                                                                                expenses; Professional Consulting
Philander      Dennis      MD   35 HIGHVIEW PL      Minneapolis       MN   55419    $1,933.96   Fees and related expenses
                                                                                                Professional Consulting Fees and
Qureshi        Adhan       MD                     - NEUROLOGY
                                UNIV OF MINNESOTAMinneapolis          MN   55455    $4,260.11   related expenses
                                                                                                Research Consulting Fees and
Reeve          Elizabeth   MD                    Minneapolis
                                4800 HAMPSHIRE AVE N                  MN   55428     $106.67    related expenses
                                                                                                Speaking Fee and related
Retterath      Patrick     MD   13000 180TH AVE NENew London          MN   56273     $104.29    expenses

                                                                                              Speaking Fee and related
                                                                                              expenses; Professional Consulting
Rhame          Frank       MD   401 S 1ST ST UNIT 702
                                                    Minneapolis       MN   55401    $5,250.06 Fees and related expenses
                                                                                              Speaking Fee and related
Rice           Kathryn     MD   4769 HAUGE CIR      Saint Paul        MN   55122    $6,182.13 expenses

                                                                                                Speaking Fee and related
                                                                                                expenses; Professional Consulting
Rogin          Joanne      MD                      LN
                                2211 AUSTRIAN PINEHopkins             MN   55305   $45,331.60   Fees and related expenses
                                                                                                Speaking Fee and related
Ross           Robert      MD   435 EASTVOLD AVE Ortonville           MN   56278    $2,378.78   expenses
                                                                                                Speaking Fee and related
Ruegemer       J Jeffrey   MD                   Excelsior
                                5105 GREENWOOD CIR                    MN   55331    $1,515.15   expenses
                                                                                                Professional Consulting Fees and
Samuelson      Thomas      MD   4700 OLD KENT RD Excelsior            MN   55331    $1,551.06   related expenses
                                                                                                Speaking Fee and related
Schapiro       Randall     MD   4295 WESTON WAY Saint Paul            MN   55126   $52,393.78   expenses
                                                                                                Speaking Fee and related
Schmitz        John        MD   2010 25TH ST S      Saint Cloud       MN   56301    $2,018.74   expenses
                                                                                                Professional Consulting Fees and
Seaquist       Elizabeth   MD   4751 DUPONT AVE S Minneapolis         MN   55419    $2,058.01   related expenses
                                                                                                Speaking Fee and related
Simons         Derek       MD                     Minneapolis
                                13235 58TH AVE N APT G                MN   55442    $1,000.00   expenses

                                                                                              Speaking Fee and related
                                                                                              expenses; Professional Consulting
Sipahimalani   Anil        MD   8359 RED OAK DR     Saint Paul        MN   55112    $2,322.17 Fees and related expenses
                                                                                              Professional Consulting Fees and
Sit            Arthur      MD   200 1ST ST SW       Rochester         MN   55905    $5,220.00 related expenses
                                                                                              Speaking Fee and related
Sivanna        Panjini     MD   1720 HIGHWAY 59 S Thief River Falls   MN   56701    $5,586.23 expenses

                                                                                                Speaking Fee and related
                                                                                                expenses; Professional Consulting
Smick          Annette     MD   100 GLADIOLA DR     Saint Charles     MN   55972   $12,991.67   Fees and related expenses
                                                                                                Speaking Fee and related
Sovell         Chase       MD                     STE 200
                                6525 FRANCE AVE S Minneapolis         MN   55435    $1,006.34   expenses
                                                                                                Speaking Fee and related
Starchook      Constanti   MD                    S
                                852 GREAT OAKS TRL aint Paul          MN   55123    $2,898.73   expenses
                                                                                                Professional Consulting Fees and
Steckelberg    James       MD   1867 SUMMIT DR NE Rochester           MN   55906    $3,323.70   related expenses
                                                                                                Speaking Fee and related
Stillman       M. Thomas   MD                     H
                                9800 SAINT JOHNS RDopkins             MN   55305   $23,427.36   expenses
                                                                                                                              Speaking Fee and related
                                                                                                                              expenses; Professional Consulting
Stillman                         Martin    MD      2671 INGLEWOOD AVE S
                                                                    Minneapolis       MN        55416              $20,970.30 Fees and related expenses
                                                                                                                              Speaking Fee and related
Stockman                         Michael   MD      9982 INDIGO DR     Eden Prairie    MN        55347               $1,568.54 expenses
                                                                                                                              Professional Consulting Fees and
Straka                           Robert    PHA     834 BALD LAKE CT   Saint Paul      MN        55123                $894.90 related expenses

                                                                                                                              Speaking Fee and related
                                                                                                                              expenses; Professional Consulting
Strinden                         Steven    MD      209 2ND ST NE      Barnesville     MN        56514               $5,527.93 Fees and related expenses

                                                                                                                              Speaking Fee and related
                                                                                                                              expenses; Professional Consulting
Sutherland                       Suzette   MD      3801 HUNTINGDON DR
                                                                    Hopkins           MN        55305              $15,565.44 Fees and related expenses
                                                                                                                              Speaking Fee and related
Varma                            Sujit     MD      2609 7TH AVE E     Hibbing         MN        55746               $1,045.07 expenses

                                                                                                                                Speaking Fee and related
                                                                                                                                expenses; Professional Consulting
Vine                             Craig     MD                        Saint Paul
                                                   2550 UNIVERSITY AVE W STE 229N     MN        55114              $24,409.03   Fees and related expenses
                                                                                                                                Speaking Fee and related
Winegarden                       Thomas    MD      18762 ERIN BAY     Eden Prairie    MN        55347               $1,016.73   expenses
                                                                                                                                Speaking Fee and related
Wirtz                            Jason     MD      3039 40TH AVE S    Minneapolis     MN        55406                 $750.00   expenses Consulting Fees and
                                                                                                                                Professional
                                                                                                                                related expenses; Research
Wyman                            Jean      NUR                      Excelsior
                                                   5955 BOULDER BRIDGE LN             MN        55331               $8,443.15   Consulting Fees and related
                                                                                                                                Speaking Fee and related
Xie                              Kevin     MD                       Sartell
                                                   903 MORNING STAR CT                MN        56377               $3,257.36   expenses
                                                                                                                                Professional Consulting Fees and
Yee                              Douglas   MD                         Saint Paul
                                                   434 MISSISSIPPI RIVER BLVD S       MN        55105               $4,210.65   related expenses
                                                                                                                                Speaking Fee and related
Zadeii                           Gino      MD      4 TROON CT         Saint Paul      MN        55110               $2,416.10   expenses
                                                                                                                                Research Consulting Fees and
ADULT & PEDIATRIC UROLOGY PLLP             UNSPI   2351 CONNECTICUT AVENUE S SUITE 200
                                                                    SARTELL          MN         56377              $11,751.00   related expenses
                                                                                                                                Research Consulting Fees and
KIDNEY SPECIALISTS OF MINNESOTA PA         UNSPI   DBA TWIN CITIES CLINICAL RSCH 6200 SHINGLE CREEK PKWY SUITE 300 $32,894.07
                                                                     BROOKLYN CTR      MN       55430                           related expenses
                                                                                                                                Research Consulting Fees and
MINNEAPOLIS CLINIC OF NEUROLOGY LTD        UNSPI   4225 GOLDEN VALLEY ROAD VALLEY
                                                                    GOLDEN            MN        55422              $25,000.00   related expenses
                                                                                                                                Research Consulting Fees and
MINNESOTA GASTROENTEROLOGY PA              UNSPI   ATTN ROSEMARY GOLT P O BOX 14909 MN
                                                                   MINNEAPOLIS                  55414               $5,272.00   related expenses

						
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