Covered Entity Details

CAH241371-04 SANFORD MEDICAL CENTER LUVERNE (Active) - information as of 5/6/2025 12:01:27 AM

Main Details

Name

SANFORD MEDICAL CENTER LUVERNE

Subdivision Name

Sanford Luverne General Surgery Clinic - Surgery

Type

Critical Access Hospital

Rural

340B ID

CAH241371-04

Medicare Provider Number

241371

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

7/12/2019

Participating Start Date

10/1/2019

Participating Approval Date

9/3/2019

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

1601 Sioux Valley Drive
Luverne, MN 56156

Billing Address

Sanford Medical Center Luverne
1600 N Kniss Avenue
Luverne, MN 56156

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 Medical Center Luverne
1600 N Kniss Avenue
Luverne, MN 56156

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
CAH241371-01	Child	CAH	SANFORD MEDICAL CENTER LUVERNE	Sanford Luverne Clinic	1601 Sioux Valley Drive	Luverne	MN	Active
CAH241371-02	Child	CAH	SANFORD MEDICAL CENTER LUVERNE	Sanford Luverne Specialty Clinic - Specialties	1601 Sioux Valley Drive	Luverne	MN	Active
CAH241371-03	Child	CAH	SANFORD MEDICAL CENTER LUVERNE	Sanford Luverne Womens Health Clinic - OB/Gyn	1601 Sioux Valley Drive	Luverne	MN	Active
CAH241371-04	Child	CAH	SANFORD MEDICAL CENTER LUVERNE	Sanford Luverne General Surgery Clinic - Surgery	1601 Sioux Valley Drive	Luverne	MN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:16:09 AM	9/3/2024 3:34:32 PM	9/3/2024 3:34 PM
Addresses	Billing Address	Insert	Change Request		Sanford Medical Center Luverne 1600 N Kniss Avenue Luverne, MN 56156	2/12/2024 7:33 AM
Addresses	Shipping Address	Insert	Change Request		Sanford Medical Center Luverne 1600 N Kniss Avenue Luverne, MN 56156	2/12/2024 7:33 AM
Details	Last Recertification Date	Update	Recertification	9/13/2022 12:48:50 PM	9/5/2023 10:16:09 AM	9/5/2023 10:16 AM
Contacts	Authorizing Official	Update	Change Request	NELSON, ALLISON Director of Finance Sanford Canby Medical Center 5072237277-273	Vanden Hull, Eric Lucas Vice President of Finance - Sioux Falls HSD Sanford Health 7122615275	3/24/2023 6:39 AM
Contacts	Primary Contact	Update	Change Request	Wrigg, Sarah Jean Pharm.D. Sanford Luverne Medical Center 5079357273	Howard, Alyssa O Director of Pharmacy Sanford USD Medical Center 6056951697	2/17/2023 6:51 AM
Contacts	Primary Contact	Update	Profile Change Request	Wrigg, Sarah Jean Pharm.D. Sanford Luverne Medical Center 5074491273	Wrigg, Sarah Jean Pharm.D. Sanford Luverne Medical Center 5079357273	11/22/2022 2:16 PM
Contacts	Primary Contact	Update	Change Request	AUSTIN, EMILLY PHARMACY MANAGER Sanford Luverne Medical Center Pharmacy 5074491302	Wrigg, Sarah Jean Pharm.D. Sanford Luverne Medical Center 5074491273	10/4/2022 12:06 PM
Details	Last Recertification Date	Update	Recertification	8/23/2021 2:52:05 PM	9/13/2022 12:48:50 PM	9/13/2022 12:48 PM
Addresses	Shipping Address	Delete	Change Request	Sanford Luverne Medical Center 1600 N Kniss Avenue Luverne, MN 56156		5/4/2022 8:06 AM
Addresses	Main Address	Update	Change Request	1600 N Kniss Avenue Luverne, MN 56156	1601 Sioux Valley Drive Luverne, MN 56156	5/4/2022 8:06 AM
Contacts	Authorizing Official	Update	Profile Change Request	NELSON, ALLISON Director of Fiscal Services Sanford Canby Medical Center 5072237277-273	NELSON, ALLISON Director of Finance Sanford Canby Medical Center 5072237277-273	2/1/2022 7:41 AM
Details	Last Recertification Date	Update	Recertification	8/27/2020 10:38:08 AM	8/23/2021 2:52:05 PM	8/23/2021 2:52 PM
Details	Last Recertification Date	Update	Recertification		8/27/2020 10:38:08 AM	8/27/2020 10:38 AM
Contacts	Authorizing Official	Update	Change Request	Knobloch, Stan Director of Finance Sanford Health Network 7124726143	NELSON, ALLISON Director of Fiscal Services Sanford Canby Medical Center 5072237277-273	12/3/2019 2:09 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Addresses	Main Address	Update	Change Request	1601 Sioux Valley Drive Luverne, MN 56156	1600 N Kniss Avenue Luverne, MN 56156	9/12/2019 11:30 AM
Addresses	Main Address	Insert	New Registration		1601 Sioux Valley Drive Luverne, MN 56156	9/3/2019 1:56 PM
Addresses	Shipping Address	Insert	New Registration		Sanford Luverne Medical Center 1600 N Kniss Avenue Luverne, MN 56156	9/3/2019 1:56 PM
Contacts	Signed By	Insert	New Registration		Knobloch, Stan Director of Finance Sanford Health Network 7124726143	9/3/2019 1:56 PM
Details	340B ID	Update	New Registration		CAH241371-04	9/3/2019 1:56 PM
Details	Entity Name	Update	New Registration	SANFORD HOSPITAL LUVERNE	SANFORD MEDICAL CENTER LUVERNE	9/3/2019 1:56 PM
Details	Entity Subname	Update	New Registration	Luverne General Surgery	Sanford Luverne General Surgery Clinic - Surgery	9/3/2019 1:56 PM
Dates	Participating Approval Date	Update	New Registration		9/3/2019 1:56:19 PM	9/3/2019 1:56 PM
Details	State	Update	New Registration	Pending	Approved	9/3/2019 1:56 PM
Dates	Signed By Date	Update	New Registration		7/30/2019 2:40:11 PM	9/3/2019 1:56 PM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	9/3/2019 1:56 PM
Addresses	Main Address	Insert	New Registration		1601 Sioux Valley Drive Luverne, MN 56156	7/12/2019 10:27 AM
Contacts	Primary Contact	Insert	New Registration		AUSTIN, EMILLY PHARMACY MANAGER Sanford Luverne Medical Center Pharmacy 5074491302	7/12/2019 10:27 AM
Contacts	Authorizing Official	Insert	New Registration		Knobloch, Stan Director of Finance Sanford Health Network 7124726143	7/12/2019 10:27 AM
Details	Last Recertification Date	Insert	New Registration			7/12/2019 10:27 AM
Details	Grant Number	Insert	New Registration			7/12/2019 10:27 AM
Details	340B ID	Insert	New Registration			7/12/2019 10:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/12/2019 10:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/12/2019 10:27 AM
Details	Medicare Provider Number	Insert	New Registration		241371	7/12/2019 10:27 AM
Details	Entity Name	Insert	New Registration		SANFORD HOSPITAL LUVERNE	7/12/2019 10:27 AM
Details	Program Code	Insert	New Registration		CAH	7/12/2019 10:27 AM
Details	Entity Subname	Insert	New Registration		Luverne General Surgery	7/12/2019 10:27 AM
Dates	Participating Approval Date	Insert	New Registration			7/12/2019 10:27 AM
Details	State	Insert	New Registration		Pending	7/12/2019 10:27 AM
Dates	Registration Date	Insert	New Registration		7/12/2019 10:27:23 AM	7/12/2019 10:27 AM
Dates	Signed By Date	Insert	New Registration			7/12/2019 10:27 AM
Dates	Start Date	Insert	New Registration			7/12/2019 10:27 AM
Terminations	Termination Comments	Insert	New Registration			7/12/2019 10:27 AM
Terminations	Termination Date	Insert	New Registration			7/12/2019 10:27 AM
Terminations	Termination Effective Date	Insert	New Registration			7/12/2019 10:27 AM
Terminations	Termination Reason	Insert	New Registration			7/12/2019 10:27 AM