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DSH430027AU Sanford USD Medical Center (Active)
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Main Details
Name
Sanford USD Medical Center
Subdivision Name
Sanford 69th & Louise Family Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH430027AU
Medicare Provider Number
430027
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
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
6101 S LOUISE AVE
SANFORD 69TH & LOUISE FAMILY MEDICINE
SIOUX FALLS, SD 57108-5981
Billing Address
Sanford USD Medical Center
1305 W 18th St
Sioux Falls, SD 57117-5039
Comments
Medicaid Billing
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Contract Pharmacies
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