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DSH240100H Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Sanford Bemidji 1705 Anne Street Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100H
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
8/12/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Sanford Health of Northern Minnesota
Lisa Sue Miller, Chief Financial Officer
(218) 333-5523
Primary Contact
Sanford Health of Northern Minnesota
Karla P Eischens, Director of Pharmacy
(218) 333-5543
Addresses
Street Address
1705 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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