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CAH351309-00 SANFORD MEDICAL CENTER MAYVILLE (Active)
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Main Details
Name
SANFORD MEDICAL CENTER MAYVILLE
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH351309-00
Medicare Provider Number
351309
Additional Details
Current Program Status
Active
Registration Date
6/15/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/2/2011
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
42 6TH AVENUE SE
MAYVILLE, ND 58257
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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