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RRC350015-40 Sanford Bismarck (Terminated)
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Main Details
Name
Sanford Bismarck
Subdivision Name
Sanford Bismarck Cardiology Clinic
Type
Rural Referral Center
Rural
No
340B ID
RRC350015-40
Medicare Provider Number
350015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/14/2013
Last Recertification Date
8/21/2015
Termination Date
Termination Reason
7/1/2016
Change of covered entity type
Contacts
Authorizing Official
Sanford Bismarck
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Primary Contact
Sanford Bismarck
Tom Simmer, Pharmacy Director
(701) 323-8606
Addresses
Street Address
222 N 7th St
Bismarck, ND 58501
Billing Address
Sanford Bismarck
300 N 7th St
Bismarck, ND 58501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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