340B Drug Pricing Program Database
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DSH240100BP Sanford Bemidji Medical Center (Terminated)
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Main Details
Name
Sanford Bemidji Medical Center
Subdivision Name
SANFORD HEALTH OF NORTHERN MINNESOT - Radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH240100BP
Medicare Provider Number
240100
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/9/2020
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
614 MICHIGAN AVE W
WALKER, MN 56484-2276
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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