340B Drug Pricing Program Database
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DSH350015BL SANFORD BISMARCK (Active)
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Main Details
Name
SANFORD BISMARCK
Subdivision Name
SANFORD BISMARCK FAMILY MEDICINE STATE STREET CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350015BL
Medicare Provider Number
350015
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/30/2018
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Sanford Bismarck
Leigh Ann Thompson, Chief Financial Officer
(701) 323-6720
Primary Contact
Sanford Bismarck
John Savageau, Director - Pharmacy
(701) 323-6186
Addresses
Street Address
3318 N 14TH ST
BISMARCK, ND 58503-1614
Billing Address
Sanford Bismarck
300 N 7th St
Bismarck, ND 58501
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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