340B Drug Pricing Program Database
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DSH240100AG Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Hospice
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100AG
Medicare Provider Number
240100
Outpatient Facility Provider Number
241511
Additional Details
Current Program Status
Terminated
Registration Date
10/5/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/5/2015
Last Recertification Date
9/12/2021
Termination Date
Termination Reason
10/1/2021
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
Matthew Aaron Webb, Director of Pharmacy
(218) 333-6339
Addresses
Street Address
3201 Pine Ridge Avenue NW
Bemidji, MN 56601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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