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DSH350015AL SANFORD BISMARCK (Terminated)
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Main Details
Name
SANFORD BISMARCK
Subdivision Name
SANFORD BISMARCK / Physiatry Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350015AL
Medicare Provider Number
350015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/11/2016
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
4/1/2019
Site closure
Contacts
Authorizing Official
Sanford Bismarck
Kirk Cristy, Vice President Finance
(701) 323-6000 Ext: 6310
Primary Contact
Sanford Bismarck
Tom Simmer, Pharmacy Director
(701) 323-8606
Addresses
Street Address
222 N 7TH ST
BISMARCK, ND 58501-4436
Billing Address
Sanford Bismarck
300 N 7th St
Bismarck, ND 58501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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