340B Drug Pricing Program Database
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DSH350011GA SANFORD MEDICAL CENTER FARGO (Active)
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Main Details
Name
SANFORD MEDICAL CENTER FARGO
Subdivision Name
Sanford Medical Center Fargo / Sanford Diabetes Education PBB - Sanford Diabetes Education PBB
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH350011GA
Medicare Provider Number
350011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/15/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/7/2019
Last Recertification Date
8/28/2024
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
4000 28th Avenue South
Moorhead, MN 56560
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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