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DSH020012 FAIRBANKS MEMORIAL HOSPITAL (Active)
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Main Details
Name
FAIRBANKS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH020012
Medicare Provider Number
020012
Additional Details
Current Program Status
Active
Registration Date
9/1/2005
Participating Start Date
9/9/2005
Participating Approval Date
9/2/2005
Last Recertification Date
8/29/2024
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
1650 COWLES STREET
FAIRBANKS, AK 99701-5998
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/13/08-CORRECTED MEDICAID # (WAS PH7525)
03/13/2008
April 2025
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