340B Drug Pricing Program Database
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DSH020012B FAIRBANKS MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
FAIRBANKS MEMORIAL HOSPITAL
Subdivision Name
FMH Radiology Satellite - Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH020012B
Medicare Provider Number
020012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2021
Participating Start Date
4/1/2021
Participating Approval Date
1/25/2021
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Fairbanks Memorial Hospital
Stephen L Duprey, Sr Director of Operations
(907) 458-3669 Ext: 73669
Primary Contact
Fairbanks Memorial Hospital
Marc J Rowden, Director of Pharmacy
(907) 458-5537
Addresses
Street Address
1001 Noble Street
Fairbanks, AK 99701
Billing Address
Fairbanks Memorial Hospital
1650 Cowles Street
Fairbanks, AK 99701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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