340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
RRC350011-76 Sanford Medical Center Fargo (Terminated)
Print
Main Details
Name
Sanford Medical Center Fargo
Subdivision Name
SANFORD BROADWAY MEDICAL BUILDING / Sanford CTC - Parkinsons Disease
Type
Rural Referral Center
Rural
No
340B ID
RRC350011-76
Medicare Provider Number
350011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/18/2016
Last Recertification Date
8/10/2016
Termination Date
Termination Reason
4/1/2017
Change of covered entity type
Contacts
Authorizing Official
Sanford Medical Center Fargo
Tiffany Lawrence, President and CEO, Fargo
(701) 417-2314
Primary Contact
Sanford Health
Jesse Breidenbach, Vice President, Pharmacy
(701) 234-6887
Addresses
Street Address
736 Broadway North
Fargo, ND 58102-4421
Billing Address
Sanford Medical Center Fargo
801 Broadway North
Fargo, ND 58102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session