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DSH430027AS SANFORD USD MEDICAL CENTER (Terminated)
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Main Details
Name
SANFORD USD MEDICAL CENTER
Subdivision Name
Sanford Dialysis Wagner
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430027AS
Medicare Provider Number
430027
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/21/2014
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Sanford Health
Cole A Turner, Vice President, Finance
(605) 328-6940
Primary Contact
Sanford USD Medical Center
MICHAEL DUNCAN, PHARMACY DIRECTOR
(605) 333-6531
Addresses
Street Address
111 Washington Avenue NW
Wagner, SD 57380
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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