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DSH350011MD SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Neuro Grand Forks Dept - Neuro Grand Forks Dept
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350011MD
Medicare Provider Number
350011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2024
Participating Start Date
1/1/2025
Participating Approval Date
11/13/2024
Last Recertification Date
Contacts
Authorizing Official
Sanford Medical Center Fargo
Kristin Herrmann, Vice President, Finance
(701) 417-2326
Primary Contact
Sanford Health
Jesse Breidenbach, Vice President, Pharmacy
(701) 234-6887
Addresses
Street Address
1750 47TH AVE S
Grand Forks, ND 58201
Billing Address
Sanford Medical Center Fargo
801 Broadway N
Fargo, ND 58102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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