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HM10193 SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
SANFORD HEALTH CENTER FOR BLEEDING AND CLOTTING DISORDERS
Type
Comprehensive Hemophilia Treatment Center
340B ID
HM10193
Grant Number
H30MC24052
Additional Details
Current Program Status
Active
Registration Date
1/1/1997
Participating Start Date
1/1/1997
Participating Approval Date
1/1/1997
Last Recertification Date
2/11/2025
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
801 Broadway N
FARGO, ND 58102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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9/29/05 - REMOVED MEDICAID #21228
01/01/1997
April 2025
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