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DSH240100N Sanford Bemidji Medical Center (Active)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
SANFORD BEMIDJI 1611 ANNE ST CLINIC / Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100N
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Sanford Health of Northern Minnesota
Lisa Sue Miller, Chief Financial Officer
(218) 333-5523
Primary Contact
Sanford Health of Northern Minnesota
Matthew Aaron Webb, Director of Pharmacy
(218) 333-6339
Addresses
Street Address
1611 ANNE ST NW
BEMIDJI, MN 56601-5114
Billing Address
Sanford Bemidji Medical Center
1300 ANNE STREET NW
BEMIDJI, MN 56601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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