Covered Entity Details

RRC350015-13 Sanford Bismarck (Terminated) - information as of 6/13/2025 2:52:05 PM

Main Details

Name

Sanford Bismarck

Subdivision Name

Sanford Bismarck Children's Oncology Clinic

Type

Rural Referral Center

Rural

340B ID

RRC350015-13

Medicare Provider Number

350015

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/10/2013

Participating Start Date

4/1/2013

Participating Approval Date

3/14/2013

Last Recertification Date

8/21/2015

Termination Date
Termination Reason

7/1/2016
Change of covered entity type

Contacts

Authorizing Official

Sanford Bismarck
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310

Primary Contact

Sanford Bismarck
Tom Simmer, Pharmacy Director
(701) 323-8606

Addresses

Street Address

222 N 7th St
Bismarck, ND 58501

Billing Address

Sanford Bismarck
300 N 7th St
Bismarck, ND 58501

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Sanford Bismarck
300 N 7th St
Bismarck, ND 58501

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
RRC350015-01	Child	RRC	Sanford Bismarck	Sanford Bismarck Children's Walk In Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-02	Child	RRC	Sanford Bismarck	Sanford Bismarck Children's Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-03	Child	RRC	Sanford Bismarck	Sanford Bismarck Plastic Surgery Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-04	Child	RRC	Sanford Bismarck	Sanford Bismarck Gastroenterology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-05	Child	RRC	Sanford Bismarck	Sanford Bismarck Rheumatology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-06	Child	RRC	Sanford Bismarck	Sanford Bismarck Urology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-07	Child	RRC	Sanford Bismarck	Sanford Bismarck Neurology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-08	Child	RRC	Sanford Bismarck	Sanford Bismarck Endocrinology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-09	Child	RRC	Sanford Bismarck	Sanford Bismarck Podiatry Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-10	Child	RRC	Sanford Bismarck	Sanford Bismarck Pulmonology Clinic	222 N 7th st	Bismarck	ND	Terminated
RRC350015-11	Child	RRC	Sanford Bismarck	Sanford Bismarck Radiology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-12	Child	RRC	Sanford Bismarck	Sanford Bismarck Neurosurgery Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-13	Child	RRC	Sanford Bismarck	Sanford Bismarck Children's Oncology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-14	Child	RRC	Sanford Bismarck	Sanford Bismarck Nephrology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-16	Child	RRC	Sanford Bismarck	Sanford Bismarck Cardiovascular Surgery Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-17	Child	RRC	Sanford Bismarck	Sanford Bismarck Internal Medicine	222 N 7th St	Bismarck	ND	Terminated
RRC350015-18	Child	RRC	Sanford Bismarck	Sanford Bismarck General Surgery Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-19	Child	RRC	Sanford Bismarck	Sanford Bismarck Physiatry Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-20	Child	RRC	Sanford Bismarck	Sanford Bismarck Oncology Clinic/Infusion Center	222 N 7th St	Bismarck	ND	Terminated
RRC350015-21	Child	RRC	Sanford Bismarck	Sanford Bismarck Orthopedics & Sports Medicine	225 N 7th St	Bismarck	ND	Terminated
RRC350015-22	Child	RRC	Sanford Bismarck	Sanford Bismarck Plastic Surgery 7th & Thayer Clinic	225 N 7th St	Bismarck	ND	Terminated
RRC350015-23	Child	RRC	Sanford Bismarck	Sanford Bismarck 7th & Thayer Podiatry Clinic	225 N 7th St	Bismarck	ND	Terminated
RRC350015-24	Child	RRC	Sanford Bismarck	Sanford Bismarck Downtown Family Medicine Clinic	209 N 7th St	Bismarck	ND	Terminated
RRC350015-25	Child	RRC	Sanford Bismarck	Sanford Bismarck Downtown Internal Medicine Clinic	209 N 7th St	Bismarck	ND	Terminated
RRC350015-26	Child	RRC	Sanford Bismarck	Sanford Bismarck Tom & Frances Leach Dialysis	209 N 7th St	Bismarck	ND	Terminated
RRC350015-27	Child	RRC	Sanford Bismarck	Sanford Bismarck Allergy Clinic	715 E Broadway Ave	Bismarck	ND	Terminated
RRC350015-28	Child	RRC	Sanford Bismarck	Sanford Bismarck Downtown Walk In Clinic	715 E Broadway Ave	Bismarck	ND	Terminated
RRC350015-29	Child	RRC	Sanford Bismarck	Sanford Bismarck Ear, Nose & Throat Clinic	715 E Broadway Ave	Bismarck	ND	Terminated
RRC350015-30	Child	RRC	Sanford Bismarck	Sanford Bismarck Obstetrics & Gynecology	414 N 7th St	Bismarck	ND	Terminated
RRC350015-31	Child	RRC	Sanford Bismarck	Sanford Bismarck Behavioral Health	414 N 7th St	Bismarck	ND	Terminated
RRC350015-32	Child	RRC	Sanford Bismarck	Sanford Bismarck Pain Managment	414 N 7th St	Bismarck	ND	Terminated
RRC350015-33	Child	RRC	Sanford Bismarck	Sanford Bismarck South Family Medicine Clinic	1040 Tacoma Ave	Bismarck	ND	Terminated
RRC350015-34	Child	RRC	Sanford Bismarck	Sanford Bismarck Mandan East Family Medicine Clinic	102 Mandan Avenue	Mandan	ND	Terminated
RRC350015-35	Child	RRC	Sanford Bismarck	Sanford Bismarck North Family Medicine Clinic	2830 N Washington St	Bismarck	ND	Terminated
RRC350015-36	Child	RRC	Sanford Bismarck	Sanford Bismarck Mandan North Family Medicine Clinic	910 18th St NW	Mandan	ND	Terminated
RRC350015-37	Child	RRC	Sanford Bismarck	Sanford Bismarck North Walk In Clinic	3318 N 14th St	Bismarck	ND	Terminated
RRC350015-38	Child	RRC	Sanford Bismarck	Sanford Bismarck Wound Care Clinic	515 E Broadway Ave	Bismarck	ND	Terminated
RRC350015-39	Child	RRC	Sanford Bismarck	Sanford Bismarck Diabetes Care Clinic	515 E Broadway Ave	Bismarck	ND	Terminated
RRC350015-40	Child	RRC	Sanford Bismarck	Sanford Bismarck Cardiology Clinic	222 N 7th St	Bismarck	ND	Terminated
RRC350015-41	Child	RRC	Sanford Bismarck	Sanford Bismarck Rehab Clinic	300 N 7th St	Bismarck	ND	Terminated
RRC350015-42	Child	RRC	Sanford Bismarck	Sanford Bismarck Downtown Nephrology	209 N 7th St	Bismarck	ND	Terminated
RRC350015-43	Child	RRC	Sanford Bismarck	Sanford Bismarck Pediatrics North	765 W Interstate Ave	Bismarck	ND	Terminated
RRC350015-44	Child	RRC	SANFORD HEALTH BISMARCK	Sanford Health Bismarck / Sanford Bismarck Dermatology	2830 N Washington St	Bismarck	ND	Terminated
RRC350015-45	Child	RRC	SANFORD HEALTH BISMARCK	Sanford Health Bismarck / Sanford Bismarck Infectious Disease	222 N 7th St	Bismarck	ND	Terminated
RRC350015-46	Child	RRC	SANFORD HEALTH BISMARCK	Sanford Health Bismarck / Sanford Bismarck Neonatology	222 N 7th St	Bismarck	ND	Terminated
RRC350015-47	Child	RRC	SANFORD HEALTH BISMARCK	SANFORD HEALTH BISMARCK / SANFORD FORT YATES DIALYSIS	10 N River Road	Fort Yates	ND	Terminated
RRC350015-48	Child	RRC	SANFORD HEALTH BISMARCK	Sanford Health Bismarck / Sanford Jamestown Dialysis	300 2nd Ave NE	Jamestown	ND	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	New Registration	Cristy, Kirk Vice President Finance Sanford Bismarck 7013236000	Cristy, Kirk Vice President Finance Sanford Bismarck 7013236000-6310	7/29/2021 11:16 AM
Contacts	Authorizing Official	Update		Cristy, Kirk Vice President Finance 7013236000	Cristy, Kirk Vice President Finance Sanford Bismarck 7013236000	10/17/2017 10:36 AM
Contacts	Primary Contact	Update		Simmer, Tom Pharmacy Director 7013238606	Simmer, Tom Pharmacy Director Sanford Bismarck 7013238606	10/12/2017 8:58 AM
Contacts	Authorizing Official	Insert			Cristy, Kirk Vice President Finance 7013236000	7/12/2017 10:51 AM
Contacts	Primary Contact	Insert			Simmer, Tom Pharmacy Director 7013238606	4/11/2017 2:53 PM
Contacts	Signed By	Insert			Schumacher, Michael R. CFO 7013236130	5/6/2016 4:13 PM
Details	State	Update		Active	Terminated	5/6/2016 4:13 PM
Terminations	Termination Comments	Update			Registration of Parent Entity as a new entity of DSH was approved.	5/6/2016 4:13 PM
Terminations	Termination Date	Update			7/1/2016 12:00:00 AM	5/6/2016 4:13 PM
Terminations	Termination Effective Date	Update			7/1/2016 12:00:00 AM	5/6/2016 4:13 PM
Terminations	Termination Reason	Update			Change of covered entity type	5/6/2016 4:13 PM
Addresses	Main Address	Insert			222 N 7th St Bismarck, ND 58501	11/9/2015 4:53 PM
Addresses	Billing Address	Insert			Sanford Bismarck 300 N 7th St Bismarck, ND 58501	11/9/2015 4:53 PM
Addresses	Shipping Address	Insert			Sanford Bismarck 300 N 7th St Bismarck, ND 58501	11/9/2015 4:53 PM
Details	Last Recertification Date	Update		8/22/2014 12:00:00 AM	8/21/2015 12:00:00 AM	8/21/2015 3:11 PM
Details	Last Recertification Date	Update		8/27/2013 10:28:52 AM	8/22/2014 12:00:00 AM	8/22/2014 11:41 AM
Details	Last Recertification Date	Update			8/27/2013 10:28:52 AM	8/27/2013 10:28 AM
Details	340B ID	Update		IS-FF-RRC350015-13	RRC350015-13	3/14/2013 11:05 AM
Dates	Participating Approval Date	Update			3/14/2013 12:00:00 AM	3/14/2013 11:05 AM
Details	State	Update		Pending	Active	3/14/2013 11:05 AM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	3/14/2013 11:05 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	IS-FF-RRC350015-13	1/17/2013 10:04 AM
Details	Last Recertification Date	Insert				1/10/2013 10:06 AM
Details	Grant Number	Insert				1/10/2013 10:06 AM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	1/10/2013 10:06 AM
Details	Is Authorizing Official EHB Data	Insert				1/10/2013 10:06 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/10/2013 10:06 AM
Details	Medicare Provider Number	Insert			350015	1/10/2013 10:06 AM
Details	Entity Name	Insert			Sanford Bismarck	1/10/2013 10:06 AM
Details	Program Code	Insert			RRC	1/10/2013 10:06 AM
Details	Entity Subname	Insert			Sanford Bismarck Children's Oncology Clinic	1/10/2013 10:06 AM
Dates	Participating Approval Date	Insert				1/10/2013 10:06 AM
Details	State	Insert			Pending	1/10/2013 10:06 AM
Dates	Registration Date	Insert			1/10/2013 12:00:00 AM	1/10/2013 10:06 AM
Dates	Signed By Date	Insert			1/10/2013 12:00:00 AM	1/10/2013 10:06 AM
Dates	Start Date	Insert				1/10/2013 10:06 AM
Terminations	Termination Comments	Insert				1/10/2013 10:06 AM
Terminations	Termination Date	Insert				1/10/2013 10:06 AM
Terminations	Termination Effective Date	Insert				1/10/2013 10:06 AM
Terminations	Termination Reason	Insert				1/10/2013 10:06 AM