340B Drug Pricing Program Database
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DSH350011BJ SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Sanford Children's SW Clinic / Sanford Southwest Peds Urgent Care PBB
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350011BJ
Medicare Provider Number
350011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/3/2017
Last Recertification Date
9/1/2024
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
2701 13TH AVE S
FARGO, ND 58103
Billing Address
Sanford Medical Center Fargo
801 Broadway North
Fargo, ND 58102
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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