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DSH240100BJ Sanford Bemidji Medical Center (Active)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
Recovery Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100BJ
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
Last Recertification Date
8/22/2024
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
1705 Anne Street 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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