340B Drug Pricing Program Database
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DSH240100AT Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Main Clinic Diabetic Education
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100AT
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
8/28/2023
Termination Date
Termination Reason
10/1/2024
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
1233 34th St NW
Bemidji, MN 56601
Billing Address
Sanford Bemidji Medical Center
1300 ANNE STREET NW
BEMIDJI, MN 56601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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