Covered Entity Details

CAH161381-01 SANFORD SHELDON MEDICAL CENTER (Active) - information as of 6/24/2025 12:05:37 AM

Main Details

Name

SANFORD SHELDON MEDICAL CENTER

Subdivision Name

SANFORD SHELDON CLINIC

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH161381-01

Medicare Provider Number

161381

Outpatient Facility Provider Number

168506

Additional Details

Current Program Status

Active

Registration Date

4/2/2013

Participating Start Date

7/1/2013

Participating Approval Date

4/23/2013

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

Sanford Health
Eric Lucas Vanden Hull, Vice President of Finance - Sioux Falls HSD
(712) 261-5275

Primary Contact

Sanford USD Medical Center
Alyssa O Howard, Director of Pharmacy
(605) 695-1697

Addresses

Street Address

800 OAK STREET
SHELDON, IA 51201-0010

Billing Address

Sanford Sheldon Medical Center
118 N. 7th Ave
Sheldon, IA 51201-1235

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 Sheldon Medical Center
118 N. 7th Ave
Sheldon, IA 51201-1235

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
CAH161381-01	Child	CAH	SANFORD SHELDON MEDICAL CENTER	SANFORD SHELDON CLINIC	800 OAK STREET	SHELDON	IA	Active
CAH161381-02	Child	CAH	SANFORD SHELDON MEDICAL CENTER	SANFORD SANBORN CLINIC	321 MAIN STREET	SANBORN	IA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:09:11 AM	9/3/2024 3:07:25 PM	9/3/2024 3:07 PM
Addresses	Billing Address	Insert	Change Request		Sanford Sheldon Medical Center 118 N. 7th Ave Sheldon, IA 51201-1235	2/9/2024 12:37 PM
Addresses	Shipping Address	Insert	Change Request		Sanford Sheldon Medical Center 118 N. 7th Ave Sheldon, IA 51201-1235	2/9/2024 12:37 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 2:09:41 PM	9/5/2023 10:09:11 AM	9/5/2023 10:09 AM
Contacts	Authorizing Official	Update	Change Request	Knobloch, Stan Director of Finance Sanford Health Network 7124726143	Vanden Hull, Eric Lucas Vice President of Finance - Sioux Falls HSD Sanford Health 7122615275	3/23/2023 4:32 PM
Contacts	Primary Contact	Update	Change Request	LUNDQUIST, APRIL PHARMACIST sanford sheldon 7123246380	Howard, Alyssa O Director of Pharmacy Sanford USD Medical Center 6056951697	2/24/2023 9:17 AM
Details	Last Recertification Date	Update	Recertification	8/30/2021 11:47:32 AM	9/12/2022 2:09:41 PM	9/12/2022 2:09 PM
Details	Last Recertification Date	Update	Recertification	8/25/2020 4:10:57 PM	8/30/2021 11:47:32 AM	8/30/2021 11:47 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 9:40:43 AM	8/25/2020 4:10:57 PM	8/25/2020 4:10 PM
Details	Last Recertification Date	Update	Recertification	8/15/2018 11:20:13 AM	9/9/2019 9:40:43 AM	9/9/2019 9:40 AM
Contacts	Authorizing Official	Update	AO Change Request	NORDAHL, RICK CHIEF EXECUTIVE OFFICER sanford sheldon 7123246020	Knobloch, Stan Director of Finance Sanford Health Network 7124726143	10/11/2018 7:57 AM
Details	Last Recertification Date	Update	Recertification	11/14/2017 11:23:15 AM	8/15/2018 11:20:13 AM	8/15/2018 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/14/2017 11:23:15 AM	11/14/2017 11:23 AM
Contacts	Primary Contact	Update	Recertification	LUNDQUIST, APRIL PHARMACIST 7123246380	LUNDQUIST, APRIL PHARMACIST sanford sheldon 7123246380	11/14/2017 9:32 AM
Contacts	Authorizing Official	Update		NORDAHL, RICK CHIEF EXECUTIVE OFFICER 7123246020	NORDAHL, RICK CHIEF EXECUTIVE OFFICER sanford sheldon 7123246020	11/14/2017 9:04 AM
Contacts	Authorizing Official	Insert			NORDAHL, RICK CHIEF EXECUTIVE OFFICER 7123246020	8/9/2017 3:24 PM
Addresses	Main Address	Insert			800 OAK STREET SHELDON, IA 51201-0010	8/10/2016 8:58 AM
Contacts	Primary Contact	Insert			LUNDQUIST, APRIL PHARMACIST 7123246380	8/10/2016 8:58 AM
Contacts	Signed By	Insert			ROSBURG, DEB CHIEF FINANCIAL OFFICER 7123246023	8/10/2016 8:58 AM
Details	Last Recertification Date	Update		8/7/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 8:58 AM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/7/2015 12:00:00 AM	8/7/2015 12:20 PM
Details	Last Recertification Date	Update		8/29/2013 9:55:09 AM	8/6/2014 12:00:00 AM	8/6/2014 9:48 AM
Details	Last Recertification Date	Update			8/29/2013 9:55:09 AM	8/29/2013 9:55 AM
Details	340B ID	Update		ISDMCAH161381-01	CAH161381-01	4/23/2013 1:11 PM
Dates	Participating Approval Date	Update			4/23/2013 12:00:00 AM	4/23/2013 1:11 PM
Details	State	Update		Pending	Active	4/23/2013 1:11 PM
Dates	Start Date	Update			7/1/2013 12:00:00 AM	4/23/2013 1:11 PM
Details	340B ID	Update		DELETE040313-No Documents Received	ISDMCAH161381-01	4/4/2013 11:45 AM
Details	State	Update		Rejected	Pending	4/4/2013 11:45 AM
Details	340B ID	Update		DM-040313	DELETE040313-No Documents Received	4/3/2013 11:16 AM
Details	State	Update		Pending	Rejected	4/3/2013 11:16 AM
Details	340B ID	Update		DM040313	DM-040313	4/3/2013 8:27 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	DM040313	4/3/2013 7:32 AM
Details	Last Recertification Date	Insert				4/2/2013 5:15 PM
Details	Grant Number	Insert				4/2/2013 5:15 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/2/2013 5:15 PM
Details	Is Authorizing Official EHB Data	Insert				4/2/2013 5:15 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/2/2013 5:15 PM
Details	Medicare Provider Number	Insert			161381	4/2/2013 5:15 PM
Details	Entity Name	Insert			SANFORD SHELDON MEDICAL CENTER	4/2/2013 5:15 PM
Details	Program Code	Insert			CAH	4/2/2013 5:15 PM
Details	Entity Subname	Insert			SANFORD SHELDON CLINIC	4/2/2013 5:15 PM
Dates	Participating Approval Date	Insert				4/2/2013 5:15 PM
Details	State	Insert			Pending	4/2/2013 5:15 PM
Dates	Registration Date	Insert			4/2/2013 12:00:00 AM	4/2/2013 5:15 PM
Dates	Signed By Date	Insert			4/2/2013 12:00:00 AM	4/2/2013 5:15 PM
Dates	Start Date	Insert				4/2/2013 5:15 PM
Terminations	Termination Comments	Insert				4/2/2013 5:15 PM
Terminations	Termination Date	Insert				4/2/2013 5:15 PM
Terminations	Termination Effective Date	Insert				4/2/2013 5:15 PM
Terminations	Termination Reason	Insert				4/2/2013 5:15 PM