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DSH240100 Sanford Bemidji Medical Center (Active)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100
Medicare Provider Number
240100
Additional Details
Current Program Status
Active
Registration Date
12/3/2009
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Sanford Health of Northern Minnesota
Lisa Sue Miller, Chief Financial Officer
(218) 333-5523
Primary Contact
Sanford Health of Northern Minnesota
Matthew Aaron Webb, Director of Pharmacy
(218) 333-6339
Addresses
Street Address
1300 ANNE STREET NW
BEMIDJI, MN 56601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/12/13 enrolled 1/1/10 thru 3/31/13, not enrolled 4/1/13 thru 9/30/13 due to inability to comply with GPO prohibition, reinstated effective 10/1/13; 3/19/13; reason given was "compliance with GPO exclusion.5/14/12 appropriate documentation provided for name change JH
09/12/2013
3/19/13; reason given was "compliance with GPO exclusion.5/14/12 appropriate documentation provided for name change JH
03/19/2013
5/14/12 appropriate documentation provided for name change JH
05/14/2012
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