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DSH240022A SANFORD WORTHINGTON MEDICAL CENTER (Active)
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Main Details
Name
SANFORD WORTHINGTON MEDICAL CENTER
Subdivision Name
Sanford Worthington Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240022A
Medicare Provider Number
240022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/13/2013
Last Recertification Date
9/3/2024
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
1680 Diagonal Rd
Worthington, MN 56187
Billing Address
Sanford Worthington Medical Center
PO Box 997
Worthington, MN 56187-0097
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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