340B Drug Pricing Program Database
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DSH240100R Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
SANFORD BEMIDJI / Podiatry
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100R
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/21/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
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
1300 ANNE ST NW
BEMIDJI, MN 56601-5114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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