340B Drug Pricing Program Database
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DSH350011 SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350011
Medicare Provider Number
350011
Additional Details
Current Program Status
Active
Registration Date
1/5/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/14/2017
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Sanford Medical Center Fargo
Kristin Herrmann, Vice President, Finance
(701) 417-2326
Primary Contact
Sanford Health
Jesse Breidenbach, Vice President, Pharmacy
(701) 234-6887
Addresses
Street Address
801 BROADWAY NORTH
FARGO, ND 58102
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Please clarify/explain what is meant by: by "This pharmacy is an IDN entity owned retail pharmacy. It is not owned directly by the covered entity but is owned by a sister corporation under common ownership, leadership structure and governance as the covered entity."
06/13/2022
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