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DSH020012C FAIRBANKS MEMORIAL HOSPITAL (Active)
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Main Details
Name
FAIRBANKS MEMORIAL HOSPITAL
Subdivision Name
FAIRBANKS MEMORIAL HOSPITAL - Internal Medicine, Senior Care & Medication Therapy Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH020012C
Medicare Provider Number
020012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/21/2024
Last Recertification Date
Contacts
Authorizing Official
Fairbanks Memorial Hospital
Stephen L Duprey, Sr Director of Operations
(907) 458-3669 Ext: 73669
Primary Contact
Fairbanks Memorial Hospital
Marc J Rowden, Director of Pharmacy
(907) 458-5537
Addresses
Street Address
1919 LATHROP ST
STE 100
FAIRBANKS, AK 99701-5937
Billing Address
Fairbanks Memorial Hospital
1650 Cowles St
Fairbanks, AK 99701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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