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CAH241381-00 SANFORD THIEF RIVER FALLS (Active)
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Main Details
Name
SANFORD THIEF RIVER FALLS
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH241381-00
Medicare Provider Number
241381
Additional Details
Current Program Status
Active
Registration Date
2/25/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/8/2011
Last Recertification Date
9/5/2024
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
3001 SANFORD PARKWAY
THIEF RIVER FALLS, MN 56701-2819
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/28/2011- DOC.RECD. TO CONFIRM NON-PROFIT STATUS
07/06/2011
April 2025
April 2025
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