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DSH240100AU Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Anne Street Clinic - Peds Psych
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100AU
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/26/2017
Last Recertification Date
9/12/2021
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Sanford Health of Northern Minnesota
Lisa Sue Miller, Chief Financial Officer
(218) 333-5523
Primary Contact
Sanford Health of Northern Minnesota
Matthew Aaron Webb, Director of Pharmacy
(218) 333-6339
Addresses
Street Address
1611 Anne Street NW
Bemidji, MN 56601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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