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DSH240022 SANFORD WORTHINGTON MEDICAL CENTER (Active)
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Main Details
Name
SANFORD WORTHINGTON MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240022
Medicare Provider Number
240022
Additional Details
Current Program Status
Active
Registration Date
12/15/2009
Participating Start Date
1/1/2010
Participating Approval Date
12/21/2009
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Sanford Health
Eric Lucas Vanden Hull, Vice President of Finance - Sioux Falls HSD
(712) 261-5275
Primary Contact
Sanford USD Medical Center
Alyssa O Howard, Director of Pharmacy
(605) 695-1697
Addresses
Street Address
1018 6TH AVENUE
WORTHINGTON, MN 56187-0097
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/23/11 - DOC. RECD TO CONFIRM NON-PROFIT STATUS 3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE; 2/4/2010- ADDED BILLING ADD; 12/15/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
09/07/2011
3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE; 2/4/2010- ADDED BILLING ADD; 12/15/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
03/24/2010
April 2025
April 2025
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