340B Drug Pricing Program Database
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DSH350015T SANFORD BISMARCK (Active)
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Main Details
Name
SANFORD BISMARCK
Subdivision Name
SANFORD BISMARCK / Mandan East Family Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350015T
Medicare Provider Number
350015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/11/2016
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Sanford Bismarck
Leigh Ann Thompson, Chief Financial Officer
(701) 323-6720
Primary Contact
Sanford Bismarck
John Savageau, Director - Pharmacy
(701) 323-6186
Addresses
Street Address
102 MANDAN AVE
SANFORD EAST MANDAN CLINIC
MANDAN, ND 58554-3771
Billing Address
Sanford Bismarck
300 N 7th St
Bismarck, ND 58501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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